Can a Subcostal Nerve Block Add Benefit to a Lateral Femoral Cutaneous Nerve Block for Open Hip Surgery

NCT04779580 | Unknown

• 1 other identifier: JSBF01
• Study Type: interventional
• Target: 10
• Locations: 0 countries
• Sites: N/A

Brief Summary

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.

Conditions

Anesthesia, Local

Keywords

Regional Anaesthesia; Hip Surgery; Lateral Femoral Cutaneous Nerve; Subcostal Nerve; Analgesia; Hip Arthroplasty

Outcome Measures

Primary Outcomes (1)

• Cutaneous area anaesthetised by lateral cutaneous nerve of thigh and subcostal nerve block using local anaesthetic

  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.

  Duration of Study (approximately 5 months)

Study Arms (1)

Intervention Group (Only Group)

EXPERIMENTAL

Only one group in this study. 10 participants to have intervention. Lateral femoral cutaneous nerve block and evaluation: Routine ECG, pulse oximetry and blood pressure monitoring will be available. Using a sterile technique, the lateral femoral nerve will be approached using an in-plane ultrasound-guided technique, using a Stimuplex Ultra 360 50mm needle (B Braun, UK). Following negative aspiration, a one off STAT injection of 5mls lidocaine 1% will be administered subcutaneously. After 10 minutes, any altered sensation will be assessed using ice to differentiate normal and altered sensation. This area will be marked on the skin using a black marker pen. Photographs will be taken and images of the procedure will be recorded. The above will then be repeated for the subcostal nerve block. The total area of anaesthesia will then be compared to the standard surgical incision for hip surgery to assess whether the subcostal nerve block will offer any further analgesia.

Procedure: Lateral Cutaneous Nerve Of The Thigh Nerve Block Using Local Anaesthetic; Procedure: Subcostal Nerve Block Using Local Anaesthetic

Interventions

Lateral Cutaneous Nerve Of The Thigh Nerve Block Using Local Anaesthetic PROCEDURE

Currently accepted aseptic conditions will be met. The lateral cutaneous nerve of the thigh will be identified on ultrasound (Sonosite X-Porte) and 5mL of 1% lidocaine will be administered around the nerve using a 50mm Stimuplex needle. The area of anaesthesia will be demarcated using ice.

Intervention Group (Only Group)

Subcostal Nerve Block Using Local Anaesthetic PROCEDURE

Currently accepted aseptic conditions will be met. The subcostal nerve will be identified on ultrasound (Sonosite X-Porte) and 5mL of 1% lidocaine will be administered around the nerve using a 50mm Stimuplex needle. The area of anaesthesia will be demarcated using ice.

Intervention Group (Only Group)

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Participant is willing and able to give informed consent for participation in the study.
• Male or Female, aged 18 years or above.

You may not qualify if:

• 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
• Sciatica
• 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

Sponsors & Collaborators

• The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust: lead

Related Publications (4)

• Rudin D, Manestar M, Ullrich O, Erhardt J, Grob K. The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint. J Bone Joint Surg Am. 2016 Apr 6;98(7):561-7. doi: 10.2106/JBJS.15.01022.

  PMID: 27053584 BACKGROUND

• Ray B, D'Souza AS, Kumar B, Marx C, Ghosh B, Gupta NK, Marx A. Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance. Clin Anat. 2010 Nov;23(8):978-84. doi: 10.1002/ca.21043.

  PMID: 20830791 BACKGROUND

• Bodner G, Bernathova M, Galiano K, Putz D, Martinoli C, Felfernig M. Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers. Reg Anesth Pain Med. 2009 May-Jun;34(3):265-8. doi: 10.1097/AAP.0b013e31819a4fc6.

  PMID: 19587628 BACKGROUND

• Anloague PA, Huijbregts P. Anatomical variations of the lumbar plexus: a descriptive anatomy study with proposed clinical implications. J Man Manip Ther. 2009;17(4):e107-14. doi: 10.1179/106698109791352201.

  PMID: 20140146 BACKGROUND

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• James Stimpson, FRCA

  Queen Elizabeth Hospital NHS Trust

  PRINCIPAL INVESTIGATOR

Central Study Contacts

James Stimpson, FRCA

CONTACT

07791089440; jimstimpy64@gmail.com

Daniel P White, FRCA

CONTACT

07791197596; dpw1g08@doctors.org.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 21, 2021
• First Posted: March 3, 2021
• Study Start: March 1, 2021
• Primary Completion: August 1, 2021
• Study Completion: August 1, 2021
• Last Updated: March 3, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share