Fascia Iliaca Versus Quadratus Lumborum Block for Pain Management in Total Hip Replacement.

Fascia Iliaca Versus Quadratus Lumborum Block for Postoperative Pain Management in Total Hip Replacement: A Comparative Prospective Randomized Study

Postoperative analgesia is essential for early ambulation of patients with hip arthroplasties as well as decreasing hospital stay time. Fascial plane blocks are emerging as a gold standard for postoperative analgesia instead of opioids and NSAIDs, with all there side effects.

The investigators aim to compare postoperative pain levels and opioid analgesic needs of fascia iliaca block versus quadratus lumborum block in patients undergoing primary total hip arthroplasty under general anesthesia.

Study Overview

• Status: Completed
• Conditions: Postoperative Opioid Requirements in Patients With Traumatic Fracture Hip
• Intervention / Treatment: Procedure: Fascia Iliaca block; Procedure: Quadratus lumborum block

• Study Type: Interventional
• Enrollment (Actual): 68
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt, 11566
    • Ain Shams University Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All patients aging between 40-60 years ASA II, III with no known hypersensitivity for local anesthetics

Exclusion Criteria:

• Patient refusal
• Known allergy to local anesthetics
• Previous femoral artery surgery
• Local infection at the site of injection
• Those on anticoagulation therapy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Fascia iliaca block for postoperative pain management in hip arthroplasty	Procedure: Fascia Iliaca block; Ultrasound guided fascia iliaca block done by palpation of anterior superior iliac spine to identify the inguinal crease, then place the ultrasound probe on it to identify the sartorius muscle. Sonographic anatomy will be identified, from superficial to deep, consisting of subcutaneous fat, the internal oblique muscle, the transverse abdominis muscle, the fascia iliaca covering the iliacus muscle and the iliacus muscle itself. The block needle will be advanced in out-of plane to puncture the fascia iliaca. With the needle tip just below the fascia iliaca, 2 ml of a local anesthetic will be injected to confirm the tip location. Once the proper position is confirmed, 40 ml of bupivacaine 0.25% will be injected superficial to the iliacus muscle and deep to the fascia iliaca.
Active Comparator: Quadratus lumborum block for postoperative pain management in hip arthroplasty	Procedure: Quadratus lumborum block; The patients will receive anterior ultrasound guided quadratus lumborum block QLB in the lateral position. The transducer will be first placed in a parasagittal orientation 3-4 cm lateral to the midline and over the sacrum to identify the L5 transverse process. The probe will then rotated into a transverse orientation with slight medial and caudal angulation to obtain a transverse oblique view at L5 transverse process .The ultrasound probe will be tilted , so the lateral end of the probe will be more cranial than the medial side of the probe to avoid the acoustic shadow of the iliac crest. Identify the quadratus lumborum and psoas major and inject the local anesthetic above the QL

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of postoperative analgesia	The investigators will measure the time to first analgesic request after giving the block	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total rescue analgesic requirements	Measuring the total rescue analgesic requirement in the postoperative period	24 hours
Functional recovery	Will be assessed by duration of hospital stay	72 hours

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): May 30, 2022
• Primary Completion (Actual): December 3, 2022
• Study Completion (Actual): December 30, 2022

Study Registration Dates

• First Submitted: June 4, 2022
• First Submitted That Met QC Criteria: August 15, 2022
• First Posted (Actual): August 17, 2022

Study Record Updates

• Last Update Posted (Actual): January 20, 2023
• Last Update Submitted That Met QC Criteria: January 19, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: opioid requirements
• Other Study ID Numbers: R118/2021

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No