ESP Block vs FIB in Patients Undergoing Hip Arthroplasty

Not Applicable

• Conditions: Hip Arthropathy
• Interventions: Procedure: Erector spinae plain block; Procedure: Fascia Iliaca block

• Registration Number: NCT05015517
• Lead Sponsor: Cairo University

Brief Summary

The aim of this study is to compare between the analgesic efficacy of ESP block and FIB in patients undergoing hip arthroplasty.

Detailed Description

Hip arthroplasty surgery is usually associated with severe postoperative pain. Several modalities are usually used for postoperative analgesia in these patients, those include; intravenous analgesia, neuraxial analgesia and peripheral nerve blocks.

Peripheral nerve blocks have several advantages such as; potent analgesia, lower motor impairment and minimal systemic complications.

Lumbar plexus block and supra-inguinal fascia iliaca block (FIB) are the most commonly performed peripheral nerve blocks for hip surgeries.

Fascia iliaca block is one of the most common techniques for pain control after hip surgeries; it can be regarded as an anterior approach of the lumbar plexus. It provides analgesia through spread of local anaesthetic to the femoral and lateral cutaneous femoral nerves.

Ultrasound guided erector spinae plane (ESP) block is a recent regional anesthetic technique. It was first described in 2016 for acute and chronic thoracic pain management. It is a paraspinal fascial plane block that provides analgesia through injecting local anesthetic drugs to block the ventral and dorsal rami of spinal nerves in the paravertebral area.

To the best of the investigators knowledge, the use of ESP block in hip surgery was only investigated in one study and few case reports. Therefore, further randomized controlled studies are needed to prove this hypothesis.

This study aims to investigate the efficacy of ESP block in hip replacement compared to the supra-inguinal FIB.

The investigators hypothesize that erector spinae block may provide better postoperative analgesia than fascia iliaca block, since erector spinae block provides analgesic cover for the entire lumbar plexus rather than just peripheral nerves provided by fasicia iliaca.

Study Timeline

• Status Verified: 2021-08
• Study First Submitted: 2021-08-10
• Study First Submitted QC: 2021-08-19
• Last Update Submitted: 2021-08-19
• Study First Posted: 2021-08-20
• Last Update Posted: 2021-08-20
• Study Start: 2021-09
• Primary Completion: 2022-09
• Study Completion: 2022-10

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 54

Inclusion Criteria

• Age between 18 and 65 years
• ASA grade I to II
• Patients scheduled for hip replacement surgeries under subarachnoid block (SAB) e.g. hip hemi-arthroplasty, total hip arthroplasty

Exclusion Criteria

• Patient refusal
• Age below 18 or above 65 years.
• ASA grade III to IV
• Patients with known allergies to any of the drugs used.
• Contraindication to SAB eg. Coagulopathy, infection at the injection site, severe cardiopulmonary disease, diabetic or other neuropathies.
• Patients receiving opioids for chronic analgesic therapy
• Inability to comprehend visual analogue scale (VAS)
• Infection at site of erector spinae or fascia iliaca block.
• Body mass index >35 kg/m2

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ESPB Group	Erector spinae plain block	This group will receive ultrasound-guided erector spinae plane block and subarachnoid block.
FIB Group	Fascia Iliaca block	This group will receive supra-inguinal fascia iliaca block and subarachnoid block .

Primary Outcome Measures

Name	Time	Method
Total morphine requirements	24 hours postoperatively	Amount of morphine required postoperatively

Secondary Outcome Measures

Name	Time	Method
Time to first postoperative analgesic request	24 hours postoperatively	If the visual analogue scale (VAS) was 4 or more, a morphine increment (2 mg) will be added to maintain a resting VAS at \<3 and the total 24-hours morphine consumption will be recorded.
Visual analogue pain score	at rest at 2, 4, 6, 12, 18, and 24 hours postoperatively	The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."
Quadriceps muscle power strength	at 6, 12 and 24 hours postoperatively	For motor block assessment, the patient knee will be fully flexed and the patient will be asked to extend it. The motor block will be classified as follows: grade 0; normal muscle power, grade 1; motor weakness, grade 2; complete motor paralysis