Lumbar Erector Spinae Plane Block vs Fascia Iliaca Block vs Lumbar Plexus Block for Postoperative Analgesia for Total Hip Arthroplasty

Lumbar Erector Spinae Plane Block vs Fascia Iliaca Block vs Lumbar Plexus Block for Postoperative Analgesia for Total Hip Arthroplasty: A Randomized Clinical Trial

This study aims to compare lumbar erector spinae plane block, fascia iliaca block, and lumbar plexus block for postoperative analgesia for hip surgery.

Study Overview

• Status: Completed
• Conditions: Analgesia; Total Hip Arthroplasty; Fascia Iliaca Block; Lumbar Plexus Block; Lumbar Erector Spinae Plane Block
• Intervention / Treatment: Other: Lumbar Erector Spinae Plane Block; Other: Fascia Iliaca Block; Other: Lumbar Plexus Block

Detailed Description

Approximately 500,000 hip arthroplasties are performed each year in the United States. Traditionally, this procedure has been performed under general anesthesia. However, neuraxial and regional anesthesia have become more commonly utilized to aid in postoperative analgesia and reduce the side effects of opioids, namely sedation, nausea, and vomiting. Postoperative pain control has a significant impact on earlier ambulation, initiation of physical therapy, better functional recovery, and overall patient satisfaction.

Lumbar erector spinae plane block (LESPB) was reported to lead to effective postoperative analgesia in hip and proximal femoral surgery.

The fascia iliaca block (FIB) is an established and effective technique, especially when US guidance and proximal approaches are used.

lumbar plexus block (LPB) could be safe because of the targeted somatic nerve block in the psoas region which prevents dispensable sympathetic block even in cardiovascular-compromised patients.

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • El-Gharbia
    • Tanta, El-Gharbia, Egypt, 31527
      • Tanta University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 18 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I-III.
• Undergoing total hip arthroplasty under spinal anesthesia.

Exclusion Criteria:

• Obesity (Body Mass Index > 30 kg/m2).
• Allergy to any drug used in the study.
• Contraindications to spinal anesthesia (such as Thrombocytopenia (platelets <100,000/mCL) and coagulopathy (INR >1.4 or insufficient time since stopping systemic anticoagulation)).
• Epilepsy.
• Psychiatric disease.
• Pre-existing neurologic deficits or neuropathies.
• Pregnancy.
• Pre-existing alcohol/opioid use disorder.
• Previously diagnosed with chronic pain.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lumbar Erector Spinae Plane Block; Patients will receive lumbar erector spinae plane block at the end of surgery.	Other: Lumbar Erector Spinae Plane Block; Patients will receive lumbar erector spinae plane block at the end of surgery.
Experimental: Fascia Iliaca Block; Patients will receive fascia iliaca block at the end of surgery.	Other: Fascia Iliaca Block; Patients will receive fascia iliaca block at the end of surgery.
Experimental: Lumbar Plexus Block; Patients will receive lumbar plexus block at the end of surgery.	Other: Lumbar Plexus Block; Patients will receive lumbar plexus block at the end of surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to the 1st rescue analgesia	Time to the first request for the rescue analgesia (time from end of block to first dose of morphine administrated) will be recorded.	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total morphine consumption in the 1st 24h	Rescue analgesia will be provided by patient-controlled analgesia (PCA) with intravenous morphine (no basal rate; bolus 1 mg, lockout 10 minutes, maximum dose 20 mg in 4 h), which will be started if the numeric rating scale (NRS)> 3. NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively.	24 hours postoperatively
Degree of pain	Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at PACU, 4, 8, 16, and 24 h postoperatively.	24 hours postoperatively
Incidence of adverse events	Incidence of adverse events such as Bradycardia, hypotension, postoperative nausea and vomiting (PONV), or any other complication will be recorded.	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Tanta University

Study record dates

Study Major Dates

• Study Start (Actual): August 29, 2024
• Primary Completion (Actual): February 15, 2025
• Study Completion (Actual): February 15, 2025

Study Registration Dates

• First Submitted: August 24, 2024
• First Submitted That Met QC Criteria: August 24, 2024
• First Posted (Actual): August 27, 2024

Study Record Updates

• Last Update Posted (Actual): April 18, 2025
• Last Update Submitted That Met QC Criteria: April 15, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Agnosia
• Other Study ID Numbers: 36264PR760/7/24

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
• IPD Sharing Time Frame: After the end of study for one year.
• IPD Sharing Access Criteria: The data will be available upon a reasonable request from the corresponding author.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

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