Anterior Iliopsoas Muscle Space Block Versus Supra-iliac Anterior Quadratus Lumborum Block in Total Hip Arthroplasty

NCT05556759 | Recruiting

• 1 other identifier: 9721-18-9-2022
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Approximately 1.66 million hip fractures happen in a year worldwide. About 95% of these fractures happen in individuals older than 60 years. Surgical treatment involving THA is considered the best option for patients with hip fractures and those with degenerative changes in the hip joint, especially in the elderly, however, it is associated with moderate to severe postoperative pain. Pain is one of the main factors limiting ambulation, increasing the risk of thromboembolism by immobility, and causing metabolic changes that affect other systems. Therefore, individualized pain management with the use of appropriate analgesia techniques is of paramount importance. Moreover, early intervention of rehabilitation aiming at a better postoperative recovery may reduce the length of hospital stay and return to daily. Effective pain management is one of the crucial components of enhanced recovery after surgery (ERAS). Numerous regional anesthetic techniques have been used to provide analgesia following THA, including intrathecal morphine, epidural analgesia, fascia iliaca block, lumber plexus block, sacral plexus block, and local infiltration analgesia, however, each of these techniques has specific limitations that prevent them from being the analgesic technique of choice for THA. Up to investigators' knowledge, there is no study done to compare the supra-iliac approach to the anterior QL block versus the Anterior iliopsoas muscle space block as pre-emptive analgesia in patients undergoing THA under general anesthesia

Conditions

Hip Arthropathy

Keywords

Anterior iliopsoas muscle space block; suprailiac anterior quadratus lumborum block; analgesia; hip arthroplasty

Outcome Measures

Primary Outcomes (1)

• changes in Visual analogue scale (VAS)score

  On a scale of 0-10, the patient will learn to quantify postoperative pain where 0= No pain and 10= Maximum worst pain

  measured at 1 hour, 3 hours,6 hours,12hours,18hours, 24 hours postoperatively

Secondary Outcomes (1)

• Total dose of rescue analgesia

  in the first 24 hours postoperatively

Study Arms (3)

control group

PLACEBO COMPARATOR

patients will be operated on under general anesthesia

Procedure: control

IPS group

ACTIVE COMPARATOR

patients will receive an ultrasound-guided anterior iliopsoas muscle space (IPS) block

Procedure: IPS

Supra-iliac QL group

ACTIVE COMPARATOR

patients will receive an ultrasound-guided supra-iliac anterior quadratus lumborum (QL) block

Procedure: Supra-iliac QL

Interventions

control PROCEDURE

patient will be operated under general anesthesia

control group

IPS PROCEDURE

patients will receive ultrasound-guided anterior IPS block with 30 ml of bupivacaine 0.25% followed by general anesthesia.

Also known as: anterior iliopsoas muscle space block

IPS group

Supra-iliac QL PROCEDURE

patients will receive ultrasound-guided supra-iliac anterior QL block with 30 ml of bupivacaine 0.25% followed by general anesthesia.

Also known as: supra-iliac anterior quadratus lumborum block

Supra-iliac QL group

Eligibility Criteria

• Age: 50 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient acceptance.
• Age 50-80 years old.
• BMI ≤ 30 kg/m2
• ASA I - III.
• Elective total hip arthroplasty under general anesthesia.

You may not qualify if:

• History of allergy to the LA agents used in this study
• Skin lesion at the needle insertion site,
• Those with bleeding disorders, sepsis, liver disease, and psychiatric disorders
• Pre-existing neurological deficit in the lower extremity
• History of chronic pain and taking analgesics
• History of cognitive dysfunction or mental illness

Sponsors & Collaborators

• Zagazig University: lead

Study Sites (1)

Faculty of medicine, zagazig university

Zagazig, Alsharqia, 4115, Egypt

RECRUITING

Related Publications (5)

• Elsharkawy H, El-Boghdadly K, Barnes TJ, Drake R, Maheshwari K, Soliman LM, Horn JL, Chin KJ. The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series. Can J Anaesth. 2019 Aug;66(8):894-906. doi: 10.1007/s12630-019-01312-z. Epub 2019 Mar 11.

  PMID: 30953311 BACKGROUND

• Dong J, Zhang Y, Chen X, Ni W, Yan H, Liu Y, Shi H, Jiang W, Zhao D, Xu T. Ultrasound-guided anterior iliopsoas muscle space block versus posterior lumbar plexus block in hip surgery in the elderly: A randomised controlled trial. Eur J Anaesthesiol. 2021 Apr 1;38(4):366-373. doi: 10.1097/EJA.0000000000001452.

  PMID: 33492871 BACKGROUND

• Chalacheewa, T, Termpornlert, S, Sa-Ngasoongsong P, Sangkum, Lisa. Regional Anesthesia for Hip Surgery Patients: Review Article. Journal of the Medical Association of Thailand 2022; 105: 152-9.

  BACKGROUND

• Dangle J, Kukreja P, Kalagara H. Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery. Curr Anesthesiol Rep 2020; 10:259-66.

  BACKGROUND

• Hockett MM, Hembrador S, Lee A. Continuous Quadratus Lumborum Block for Postoperative Pain in Total Hip Arthroplasty: A Case Report. A A Case Rep. 2016 Sep 15;7(6):129-31. doi: 10.1213/XAA.0000000000000363.

  PMID: 27513972 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

• Shereen E Abd Ellatif, MD

  Faculty of medicine, zagazig university

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Shereen E Abd Ellatif, MD

CONTACT

01007948840; shosh.again@gmail.com

Naglaa F Abdelhaleem, MD

CONTACT

01003103036; nogaahmedkareem.fa@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: double-blinded(participants and outcome assessors)
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: associate professor of anesthesia and surgical intensive care

Model Details: The patients will be divided randomly by a computer-generated randomization table into three groups: Group C :(Control group) patients will be operated on under general anesthesia. Group IPS: patients will receive anterior IPS block with 30 ml of bupivacaine 0.25% followed by general anesthesia. Group Supra-iliac QL: patients will receive supra-iliac anterior QL block with 30 ml of bupivacaine 0.25% followed by general anesthesia.

Study Record Dates

• First Submitted: September 20, 2022
• First Posted: September 27, 2022
• Study Start: September 30, 2022
• Primary Completion: October 1, 2025
• Study Completion: November 1, 2025
• Last Updated: July 15, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: planned after the completion of the study and publication
• Access Criteria: contact with principal investigator

Locations

EG (1)