The Analgesic Efficacy of the Ultrasound-Guided Femoral Articular Branch Block for Ambulatory Hip Arthroscopy
- Conditions
- Anesthesia, Regional
- Interventions
- Procedure: Placebo BlockProcedure: Femoral Articular Branch Block
- Registration Number
- NCT03449680
- Lead Sponsor
- Women's College Hospital
- Brief Summary
Hip arthroscopy surgery can be associated with significant pain. A regional anesthesia technique, the femoral articular branch block (FAB), has recently been proposed to collectively block terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscles. The investigators aim to demonstrate the analgesic benefits of FAB. The investigators hypothesize that FAB will reduce opioid consumption and improve postoperative quality of recovery in patients having hip arthroscopy. This is a randomized, controlled, double-blind study and half the patients will be randomized to receive the femoral articular branch block and the other half of patients will be randomized to receive a placebo block. A comparison of pain will be made between both groups.
- Detailed Description
Hip arthroscopy is a surgical technique that is gaining popularity for its diagnostic and therapeutic role in the management of adult hip pain. This procedure is frequently associated with severe post-operative pain despite the practice of injecting the hip joint with local anesthetics at the end of the procedure and the use of intraoperative opioids. The ideal analgesic technique that provides adequate pain relief following this procedure has not been established yet.
There is evidence to suggest that a femoral nerve block (FNB) may provide clinically meaningful analgesia. The investigators have examined the benefits of FNB both retrospectively and prospectively in hip arthroscopy patients at Women's College Hospital (WCH). Both of our studies suggested modest benefits of the FNB in terms of controlling post-operative pain and reducing opioid consumption. However the majority of patients continued to experience moderate to severe post-operative pain and required significant amounts of opioid analgesics in the Peri-Anesthesia Unit (PAU), despite receiving the FNB.
Another regional anesthesia technique, the femoral articular branch block (FAB) has recently been proposed to collectively block the terminal femoral and accessory obturator nerve branches to the hip joint with a single injection, theoretically blocking most of the innervation relevant to hip arthroscopy while sparing the main femoral nerve branches to the quadriceps muscle. The investigators aim to demonstrate the analgesic benefits of FAB.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 94
- American Society of Anesthesiologists (ASA) physical classification system, ASA I-III patients
- 18 - 60 years of age
- Body Mass Index (BMI) <35 kg/m2
- Pre-existing neurological deficits or peripheral neuropathy in the distribution of femoral, obturator, or lateral cutaneous nerves
- Local infection
- Contra-indication to regional anesthesia e.g. bleeding diathesis, coagulopathy
- Chronic pain disorders
- History of using over 30mg of oxycodone or equivalent per day
- Contraindication to a component of multi-modal analgesia
- Allergy to local anesthesia
- History of significant psychiatric conditions that may affect patient assessment
- Pregnancy
- Inability to provide informed consent
- Patient refusal of femoral articular branch block
- Revision arthroscopy surgeries
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Block Placebo Block Patients will receive an ultrasound simulation of the location of a femoral articular branch block , this is to maintain blinding. A subcutaneous injection of 1ml of normal sterile saline will be administered Femoral Articular Branch Block Femoral Articular Branch Block Patients will receive an ultrasound-guided femoral articular branch block with an injection of 20ml of ropivicaine 0.5%
- Primary Outcome Measures
Name Time Method Quality of Life scores 24 hours postoperatively Quality of Recovery (QR15) scores at 24 hours will be the second primary outcome.
QR15 is a measurement of quality of recovery after surgery and anesthesia that has been psychometrically tested and validated. Reporting of outcome measures on a scale of 0 to 10 (0=None of the time and 10=All of the time). There are a total of 40 items/questions.Analgesic Consumption 24 hours postoperatively Postoperative cumulative oral morphine equivalent consumption during the first 24 hours will be the first primary outcome
- Secondary Outcome Measures
Name Time Method Presence of Block-related complications Up until one month following nerve block vascular puncture, hematoma formation, intravascular injection, epidural anesthesia-bilateral sensory block Presence/ absence of residual paresthesia or numbness over femoral, obturator, and lateral cutaneous nerves distribution
Analgesic Consumption Up to 48 hours following surgery Consumption intra-operatively, total in-hospital postoperative consumption, and time to first analgesic request in the first 24 hours, cumulative oral morphine equivalent
Incidence of opioid-related side effects Up until one month following nerve block nausea, vomiting, pruritus, sedation
Pain Assessment (VAS) Up to 48 hours post-operatively and at 7-day mark Visual Analogue Scale(VAS) - Pain:Overall pain assessed at rest and on movement A continuous scale comprised of a 100mm (10cm) horizontal line, anchored by 2 verbal descriptions No Pain to Worst Pain
Patient Satisfaction with Analgesic Technique One month after surgery A Patient Diary will be completed to assess overall satisfaction with analgesic technique
Turn over time after surgery up to discharge, assessed up to 24 hours PAU leaving time
Demographic Data Day 1 - first 24 hours Patient demographics - There is no scale, just questions asked of the participant.
Trial Locations
- Locations (1)
Women's College Hospital
🇨🇦Toronto, Ontario, Canada