Analgesic Efficacy of Combined Lumbar Erector Spinae Plane Block and Pericapsular Nerve Group Block in Patients Undergoing Hip Surgeries
Trial Snapshot
- Phase
- Phase 4
- Status
- Completed
- Sponsor
- Menoufia University
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- Postoperative pain intensity
Study Overview
Brief Summary
The investigators are going to evaluate the postoperative analgesic efficacy of combined LESPB and PENG block after hip surgeries.
Detailed Description
Hip surgeries are very common surgeries and has high postoperative pain potential. There are different ways to execute postoperative analgesia and each of them has advantages and disadvantages. As the patients submitted to this procedure are usually older and with multiple comorbidities, analgesia options with better profile of adverse effects should be preferred. Peripheral nerve block with long-acting local anesthetics is very suitable in this situation, in comparison with systemic or neuraxial opioids.
Pain control after total hip arthroplasty (THA) can be challenging because of complex innervation of the hip joint from both the lumbar and sacral nerve plexus. pain was the cause of 12% of unplanned hospital patient admissions, 60% of these patients were admitted for orthopedic concerns. The consequences of severe postoperative pain are prolonged hospital stay, increase hospital readmission, precipitation in the use of opioids with subsequent increase in postoperative nausea and vomiting, and overall low patient satisfaction. Furthermore, postoperative pain can seriously impact the physical and mental health of the patient and lead to secondary complications such as nausea, vomiting, slowed bowel movements, muscle spasms, thrombosis, cardiopulmonary complications and delayed recovery of organ functions.
The hip joint is innervated by the articular branches of multiple nerves that emerge from the lumbosacral plexus (L2-S1). The nerve supply to a specific region of the joint typically corresponds to the innervation of the muscle that crosses it :-
- The femoral nerve innervates the anterior aspect
- The obturator nerve supplies the inferior aspect
- The superior gluteal nerve supplies the superior aspect
- The nerve to the quadratus femoris innervates the posterior aspect.
Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Patients aged 18-70 years old
- •American Society of Anesthesiologists (ASA) class I to III
- •Scheduled for hip surgery.
Exclusion Criteria
- •Refusal to participate
- •Allergy to any of the study drugs
- •Bleeding disorder
- •Localized infection
- •Neurological disease
- •Renal impairment
- •Psychological disorders
- •Opioid dependent
- •Intellectual disability (patients unable to express pain with visual analogue)
- •Morbid obesity.
Arms & Interventions
Group A: L-ESPB and PENG
receiving after end of hip surgery (PENG) block first and (LESPB) at lumber 4 vertebrae level
Intervention: Ultrasound guided L-ESPB and PENG block using Bupivacaine (Procedure)
Group B: conventional analgesia
receiving postoperative conventional analgesia in form of acetaminophen 15 mg/kg/6hrs
Intervention: Postoperative conventional analgesia in form of Acetaminophen (Drug)
Outcomes
Primary Outcomes
Postoperative pain intensity
Time Frame: at 24 hour after the block
Postoperative pain intensity using Visual Analogue Scale (VAS) (which is over 10 centimeter scale) (where 0 indicates no pain at all , 10 indicates severe pain)
Secondary Outcomes
- Vital signs(assessed at preoperative, postoperative (0,3,6,12,24 hours), Value is averaged of total measurements)
- Time to first analgesic administration(24 hours postoperative)
- Patient satisfaction(24 hours after the block)
- Total Analgesic Requirements(24 hours postoperative)
- Block failure (patients still feeling pain immediately after 1 hour from block)(1 hour after the block)
- Adverse events(24 hours after the block)
Investigators
Ibrahim Walash
Assistant Lecturer of anesthesia, intensive care and pain management
Menoufia University
