Optimising Analgesia for Lateral Hip Arthroplasty Incision: Can a Subcostal Nerve Block Add Benefit to a Lateral Femoral Cutaneous Nerve Block?
试验速览
- 阶段
- 不适用
- 入组人数
- 10
- 主要终点
- Cutaneous area anaesthetised by lateral cutaneous nerve of thigh and subcostal nerve block using local anaesthetic
研究概览
简要总结
Hip Surgery is a very common form of surgery carried out across many hospitals within the UK in emergency and elective form. There is a variation between amongst surgeons with regard to the initial surgical incision required for the operation. It is fairly common practice to anaesthetise the Lateral Cutaneous Nerve of the thigh for analgesic reasons prior to the start of surgery, however due to the variation in surgical practice (and evolving surgical practices) this may not cover the entire surgical incision site. Another group of nerves termed the subcostal nerves has been described in the texts to perhaps cover the area of surgical incision along with blockade of the lateral cutaneous nerve of the thigh. On healthy volunteers the investigators plan to anaesthetise the lateral cutaneous nerve of the thigh, and the subcostal nerve on healthy participants to ascertain and map out the area of anaesthesia to see whether this could be a viable technique for analgesia for hip surgery in the future.
详细描述
Hip replacement and hemiarthroplasty of the hip for neck of femur fracture are common orthopaedic procedures. The National Joint Registry in 2017 reported that 96.3% of hip replacements were performed using the anterolateral and posterior approach. NICE guidelines have suggested to utilise the anterolateral approach for hip fracture hemiarthroplasty due to decrease dislocation rates and thus, cost savings.
Despite these two commonly use approaches, the traditional incisions have, in the investigators experience, been modified. This is to accommodate the increasing evidence and emphasis on the acetabular components. Besides that, in hemiarthroplasty, various incisions have been described for the 'anterolateral' approach, such as direct lateral, curved posteriorly. 'Mini' and 'micro' incisions of the posterior approach has also been described all with the aim as tissue-sparing procedures, improving outcomes and length of stay.
In this study, the investigators aim to describe the 'traditionally' described posterior and anterolateral incisions to the hip by Moore and Hardinge:
- Posterior - 5cm distally from the greater trochanter along the femoral diaphysis, curving the incision proximally 3-8cm towards the PSIS
- Anterolateral - 3cm distally from the greater trochanter along the femoral diaphysis, continuing proximally 3-8cm along the femoral diaphysis
The cutaneous innervation for this area is largely supplied by the lateral femoral cutaneous nerve of the thigh; however some anatomical texts also describe contribution to this area from the subcostal nerve, or the lateral branches of the iliohypogastric nerve.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Participant is willing and able to give informed consent for participation in the study.
- •Male or Female, aged 18 years or above.
排除标准
- •The participant may not enter the study if ANY of the following apply:
- •Peripheral neuropathy of any aetiology
- •Diabetes mellitus
- •Meralgia paraesthetica
- •Previous Total Hip Arthroplasty
- •Spinal Stenosis
- •Localised infection of the inguinal or gluteal regions
- •Allergy to local anaesthetic or excipients
- •Inability to identify either the lateral femoral cutaneous nerve or the subcostal nerve using ultrasound
结局指标
主要结局
Cutaneous area anaesthetised by lateral cutaneous nerve of thigh and subcostal nerve block using local anaesthetic
时间窗: Duration of Study (approximately 5 months)
Demarcated area of sensory loss after lateral femoral cutaneous nerve block and subcostal nerve block - reported by the participant upon testing the area with cold ice by the investigators. The area will then be assessed by the investigators to assess whether the area of anaesthesia will cover the surgical incision site for hip arthroplasties.
次要结局
未报告次要终点