LPB Combined with QLB Using Single-needle Technique (LPQLB-SNT) for Hip Arthroplasty

NCT04266236 | Completed

• 1 other identifier: 2020-031
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to effectively relieve pain and restore function in patients with hip osteoarthritis, osteonecrosis of femoral head and hip fracture.The Lumbar Plexus Block (LPB) is currently used as the standard regional anesthesia technique to provide postoperative pain management after THA. The lumbar plexus (LP) originates from T12 to L5. In general, multiple-needle nerve blockade procedure is needed to block different branches of LP. Therefore, we need more time to finish the regional anethesia procedure and it's not easy for an inexperienced anesthesiologist to master the technique absolutely. In addition, multiple injections will increase the discomfort of the patients. We aim to investigate the effects of lumbar plexus combined with quadratus lumborum block using single-needle technique with Shamrock method as an alternative regional anesthesia.

Conditions

Hip Osteoarthritis; Anesthesia, Local; Hip Fractures; Osteonecrosis of Femoral Head

Keywords

lumbar plexus block; quadratus lumorum block; total hip arthroplasty; single-needle; shamrock approach

Outcome Measures

Primary Outcomes (1)

• sensory block assessment

  The sensory block will be assessed by cold alcohol swab and pinprick at lateral, anterior and medial areas of thigh and postero-lateral area of gluteus using a 0 to 2 point scale. 0= no block, patients can feel cold; 1= analgesic block, patient can feel touch but not cold; 2= anesthetic block, patient cannot feel cold or touch.

  30 minutes after nerve block procedure

Secondary Outcomes (8)

• postoperative static pain at timepoint 1

  at 30mins after the patient recover from general anesthesia

• postoperative static pain at timepoint 2

  at 6 hours after surgery

• postoperative static pain at timepoint 3

  at 12 hours after surgery

• postoperative static pain at timepoint 4

  at 24 hours after surgery

• Performance time of block

  During nerve block procedure

Study Arms (3)

L3 LPB technique (P group)

ACTIVE COMPARATOR

ultrasound-guided shamrock approach L3 lumbar plexus block with single-needle technique

Procedure: L3 LPB; Drug: 0.375%ropivacaine 25 ml (Raropin); Procedure: General anesthesia with tracheal intubation

T12 combined with L3 and L4 LPB technique (TP group)

ACTIVE COMPARATOR

ultrasound-guided posterior approach thoracic 12 combined with L3 and L4 lumbar plexus block with mulitple-needle technique

Procedure: L3 LPB; Procedure: L4 LPB; Procedure: T12 block; Drug: 0.375%ropivacaine 40 ml (Raropin); Procedure: General anesthesia with tracheal intubation

L3 LPB combined with QLB (LPQLB-SNT, PQ group)

EXPERIMENTAL

ultrasound-guided shamrock approach L3 lumbar plexus block combined with quadratus lumborum block with single-needle technique

Procedure: L3 LPB; Procedure: L3 QLB; Drug: 0.375%ropivacaine 40 ml (Raropin); Procedure: General anesthesia with tracheal intubation

Interventions

L3 LPB PROCEDURE

ultrasound-guided L3 lumbar plexus block

L3 LPB combined with QLB (LPQLB-SNT, PQ group); L3 LPB technique (P group); T12 combined with L3 and L4 LPB technique (TP group)

L4 LPB PROCEDURE

ultrasound-guided L4 lumbar plexus block

T12 combined with L3 and L4 LPB technique (TP group)

T12 block PROCEDURE

ultrasound-guided thoracic 12th segment nerve block

T12 combined with L3 and L4 LPB technique (TP group)

L3 QLB PROCEDURE

ultrasound-guided quadratus lumborum block at L3 level

L3 LPB combined with QLB (LPQLB-SNT, PQ group)

0.375%ropivacaine 25 ml (Raropin) DRUG

0.375%ropivacaine (Raropin) 25ml will be given

L3 LPB technique (P group)

0.375%ropivacaine 40 ml (Raropin) DRUG

0.375%ropivacaine (Raropin) 40ml will be given

L3 LPB combined with QLB (LPQLB-SNT, PQ group); T12 combined with L3 and L4 LPB technique (TP group)

General anesthesia with tracheal intubation PROCEDURE

General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation

L3 LPB combined with QLB (LPQLB-SNT, PQ group); L3 LPB technique (P group); T12 combined with L3 and L4 LPB technique (TP group)

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Body mass index (BMI) between 18.5 and 30kg/m2 and the weight ≥50kg
• American Society of Anesthesiologists (ASA) classification I-II
• Postero-lateral operative incision approach unilateral hip arthroplasty
• Aged 18-75

You may not qualify if:

• Patient refusal
• Patients with coagulopathy or on therapeutic anticoagulation
• Pregnancy
• Multiple trauma
• Hypersensitivity or allergy to ropivacaine
• History of ankylosing spondylitis or spinal surgery
• Lower extremity neuropathy
• Unable to communicate

Sponsors & Collaborators

• Shanghai 6th People's Hospital: lead

Study Sites (1)

Shanghai Jiao Tong University Affiliated Sixth People's Hospital

Shanghai, Shanghai Municipality, 200233, China

Location

Related Publications (2)

• Wang X, Zhang J, Xie Z, Chen Y, Yonglin-Chen, Rao Z, Zhang H. Efficacy and safety of combined lumbar plexus and quadratus lumborum block via Shamrock approach at L3 in total hip arthroplasty: a prospective randomized controlled trial. Trials. 2025 Nov 4;26(1):467. doi: 10.1186/s13063-025-09195-w.

  PMID: 41188948 DERIVED

• Wang X, Zhang H, Chen Y, Xie Z, Chen M, Chen Y, Zhang J. The anesthetic efficacy of ultrasound-guided lumbar plexus combined with quadratus lumborum block with Shamrock approach in total hip arthroplasty: study protocol for a randomized controlled trial. Trials. 2023 Sep 18;24(1):596. doi: 10.1186/s13063-023-07619-z.

  PMID: 37718446 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Hip; Hip Fractures; Femur Head Necrosis

Interventions

Anesthesia, General; Intubation, Intratracheal

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries; Osteonecrosis; Bone Diseases; Necrosis; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthesia; Anesthesia and Analgesia; Airway Management; Therapeutics; Intubation; Investigative Techniques

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Attending doctor

Study Record Dates

• First Submitted: February 10, 2020
• First Posted: February 12, 2020
• Study Start: July 9, 2020
• Primary Completion: May 31, 2024
• Study Completion: June 30, 2024
• Last Updated: February 10, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)