Ultrasound Guided Fascia Iliaca Block for Pain Control After Elective Hip Replacement Surgery
- Conditions
- Fascia Iliaca BlockArthroplasty, Replacement, Hip
- Interventions
- Drug: SalineDrug: .2% RopivacaineProcedure: Fascia Iliaca Block
- Registration Number
- NCT02108847
- Lead Sponsor
- University of Saskatchewan
- Brief Summary
The purpose of this study is to determine whether ultrasound guided fascia iliaca blocks performed before surgery help to reduce pain after elective total hip replacements.
- Detailed Description
Total hip arthroplasty is associated with moderate to severe pain in the acute postoperative period, which can increase the risk of postoperative complications such as thromboembolism, myocardial ischemia/infarction, pneumonia, poor wound healing, insomnia, and delirium.
Sensory innervation of the hip joint comes from a combination of peripheral nerves, including femoral, obturator, sciatic, superior gluteal, and nerve for the quadratus femoris muscle. Superficial innervation of the skin involved in incision for hip arthroplasty comes from the lateral femoral cutaneous nerve (LFCN).
The fascia iliaca block (FIB) was originally described in 1989 using a landmark technique. The ultrasound guided FIB was introduced in recent years, and has been shown to produce a better quality of block than the landmark technique. It appears to consistently block the femoral and LFCN, while being less successful in achieving consistent obturator blockade.
The FIB is effective for analgesia for hip fracture injuries in the emergency department. Thus far, there has been limited exploration into the potential use of this block as a tool for postoperative analgesia after elective hip arthroplasty. The potential benefits of this regional block, as with other regional techniques, include better analgesia, less opioid use and associated side effects, and an improved overall patient satisfaction with postoperative recovery.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 42
- American Society of Anesthesiologists' (ASA) score I, II or III
- Scheduled for elective total hip arthroplasty
- Contraindication to regional anesthesia (allergy to local anesthetic, coagulopathy, infection or malignancy in the area)
- Neurologic disorder affecting the ability to sense pain
- Long term opioid use or chronic pain disorder
- History of drug or alcohol abuse
- Patient refusal
- Pregnancy
- Revision procedures
- General anesthetic
- Psychiatric or mental conditions that may affect assessment of outcomes
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Fascia Iliaca Block - Saline Fascia Iliaca Block Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of Saline. Fascia Iliaca Block - Saline Saline Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of Saline. Fascia Iliaca Block - Ropivacaine .2% Ropivacaine Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of 0.2% ropivacaine. Fascia Iliaca Block - Ropivacaine Fascia Iliaca Block Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of 0.2% ropivacaine.
- Primary Outcome Measures
Name Time Method Cumulative opioid consumption 24 hours after surgery Dilaudid will be used for analgesia postoperatively. If there is a contraindication to Dilaudid, another opioid will be ordered for analgesia, and doses will subsequently be converted back to Dilaudid equivalent doses for comparison
- Secondary Outcome Measures
Name Time Method Cumulative opioid consumption 4, 8, and 48 hours after surgery Dilaudid will be used for analgesia postoperatively. If there is a contraindication to Dilaudid, another opioid will be ordered for analgesia, and doses will subsequently be converted back to Dilaudid equivalent doses for comparison
Opioid side effect (nausea/vomiting, pruritus, constipation, urinary retention, sedation) PACU, 4, 8, 12, 24, and 48 hours after surgery Presence of each side effect documented as "yes" or "no". Sedation will be assessed by the Ramsay Sedation Scale.
Verbal pain score (static and dynamic) PACU, 4, 8, 12, 24, and 48 hours after surgery Pain score 0-10 with 10 being worst possible pain
Overall patient satisfaction 48 hours after surgery Satisfaction rated as: very dissatisfied, dissatisfied, neutral, satisfied, or very satisfied
Trial Locations
- Locations (1)
Saskatoon City Hospital
🇨🇦Saskatoon, Saskatchewan, Canada