Quadratus Lumborum Block Versus Fascia Iliaca Block for Hip Arthroplasty

NCT04005326 | Unknown DMC

• 1 other identifier: N-144-2018
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

Quadratus lumborum block is a newly developed block with good performance in lower abdominal surgery. In a cadaveric study, the spread of local anesthetic in the anterior approach of QL block (QL3) was reported to cover nerve roots from T10 to L3. Thus, it was hypothesized that this approach could be used in hip surgeries with minimal motor affection. This study aims to compare QL3 block and suprainguinal Fascia Iliaca block in the duration of postoperative analgesia, pain scores, motor power in quadriceps muscle, and side effects.

Conditions

Post Operative Pain

Outcome Measures

Primary Outcomes (1)

• Duration of analgesia

  If the visual analogue scale (VAS) is 4 or more, a 2 mg morphine increment will be added per time to maintain a resting VAS at \<3 with maximum total 24-hours morphine 10 mg.

  24 hours postoperative

Secondary Outcomes (8)

• Static visual analogue pain scale

  24 hours postoperative

• Dynamic visual analogue pain scale

  24 hours postoperative

• Onset of sensory block of quadratus lumborum block and fascia iliaca block

  30 minutes

• Time to first postoperative analgesic request

  24 hours postoperative

• Total morphine requirements

  24 hours postoperative

Study Arms (2)

QLB Group

EXPERIMENTAL

this group will receive ultrasound-guided transmuscular quadratus lumborum block; (Anterior QLB or QLB III)

Procedure: quadratus lumborum block; (Anterior QLB or QLB III); Procedure: Subarachnoid block

FIB Group

EXPERIMENTAL

this group will receive suprainguinal fascia iliaca block

Procedure: suprainguinal fascia iliaca block; Procedure: Subarachnoid block

Interventions

quadratus lumborum block; (Anterior QLB or QLB III) PROCEDURE

The patient will be in the lateral position. A low frequency convex probe will be vertically attached above the iliac crest and a needle will be inserted in plane from the posterior edge of the convex probe through the quadratus lumborum in an anteromedial direction. The needle tip will be placed between the psoas major muscle and the quadratus lumborum muscle. After negative aspiration, 30 mL of 0.25 % of bupivacaine will be injected into the fascial plane incrementally, aspirating every 5 ml.

QLB Group

suprainguinal fascia iliaca block PROCEDURE

In supine position, a high frequency linear probe will be placed in the inguinal crease. Scan starting laterally from the femoral artery and nerve in inguinal crease to identify the sartorius muscle, tracing the muscle until it's origin to anterior superior iliac spine. The shadow of the bony of iliac crest \& iliacus muscle will be seen, the end point of the injection is deep to the fascia iliaca and above the iliacus muscle in the lateral part of the iliacus muscle. After negative aspiration, 30 mL of 0.25 % of bupivacaine will be injected under the fascial plane incrementally, aspirating every 5 ml.

FIB Group

Subarachnoid block PROCEDURE

Patients will receive SAB using 25g spinal needle in the lateral position. Fifteen milligrams of hyperbaric bupivacaine will be administered at L3-L4 or at L4-L5 interspace in addition to 25 mcg fentanyl with rapid crystalloid co-load. Spinal anesthesia will be considered successful when a bilateral block to T12, as assessed by loss of cold (cold ice) and pain (a 23-gauge needle) sensations, will be established 10 -minutes after the intrathecal injection. If spinal anesthesia failed, such patients will be administered general anesthesia and will be excluded from this study.

Also known as: spinal anesthesia

FIB Group; QLB Group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients scheduled for hip replacement surgeries under subarachnoid block (SAB). e.g. hip hemiarthroplasty, total hip arthroplasty.

You may not qualify if:

• Coagulopathy, infection at the injection site,.
• Allergy to local anesthetics.
• Severe cardiopulmonary disease (≥ASA IV),.
• Diabetic or other neuropathies.
• Patients receiving opioids for chronic analgesic therapy.
• Contraindication to spinal anesthesia.
• Inability to comprehend visual analogue scale (VAS).

Sponsors & Collaborators

• Bassant M. Abdelhamid: lead

Study Sites (1)

Anesthesia Department

Cairo, 1772, Egypt

RECRUITING

Related Publications (5)

• Bullock WM, Yalamuri SM, Gregory SH, Auyong DB, Grant SA. Ultrasound-Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergoing Total Hip Arthroplasty. J Ultrasound Med. 2017 Feb;36(2):433-438. doi: 10.7863/ultra.16.03012. Epub 2016 Dec 10.

  PMID: 27943417 BACKGROUND

• Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):550-2. doi: 10.4103/0970-9185.119148.

  PMID: 24249997 BACKGROUND

• Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:2752876. doi: 10.1155/2017/2752876. Epub 2017 Jan 3.

  PMID: 28154824 BACKGROUND

• Bang S, Chung J, Jeong J, Bak H, Kim D. Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty: A prospective, randomized trial. Medicine (Baltimore). 2016 Sep;95(39):e5018. doi: 10.1097/MD.0000000000005018.

  PMID: 27684871 BACKGROUND

• Nassar H, Hasanin A, Sewilam M, Ahmed H, Abo-Elsoud M, Taalab O, Rady A, Zoheir HA. Transmuscular Quadratus Lumborum Block versus Suprainguinal Fascia Iliaca Block for Hip Arthroplasty: A Randomized, Controlled Pilot Study. Local Reg Anesth. 2021 Apr 20;14:67-74. doi: 10.2147/LRA.S308964. eCollection 2021.

  PMID: 33907462 DERIVED

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Anesthesia, Spinal

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia

Study Officials

• Ahmed M. Hasanin, M.D.

  Cairo University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ahmed M. Hasanin, M.D.

CONTACT

+201095076954; ahmedmohamedhasanin@gmail.com

Mahmoud swilem

CONTACT

+201008855731; mr.sewilam@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: associate professor

Study Record Dates

• First Submitted: June 26, 2019
• First Posted: July 2, 2019
• Study Start: July 5, 2019
• Primary Completion: October 5, 2019
• Study Completion: October 15, 2019
• Last Updated: July 8, 2019

Record last verified: 2019-07

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)