Erector Spinae vs Fascia Iliaca Block in Hip Arthroplasty (ESFIBHA)

Hospital Beatriz Ângelo

Status: Withdrawn

Conditions: Pain, Postoperative

Treatments: Procedure: Single-shot fascia iliaca block; Procedure: Single-shot erector spinae plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT03860324

45149

Details and patient eligibility

About

The thoracic erector spinae plane (ESP) block was first described by Forero et al in September 2016. In their article, the authors presented the possibility of using this block as an option for the control of thoracic neuropathic pain as well as post-operative thoracic pain. The ESP block is done by administering local anesthetic in the plane deep to the erector spinae muscle, which spreads through the costotransverse foramen to the dorsal and ventral roots of the spinal nerves.

Since then, there have been reports about the successful use of this block for bariatric surgery, ventral hernia repair, radical mastectomy, rib fractures, major abdominal surgery and hip replacement. However, there are no studies in the literature comparing the efficacy of the ESP block to other nerve blocks.

The purpose of this study is to compare the post-operative analgesic efficacy of the ESP block to the fascia iliaca (FI) block after total hip replacement (THR).

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Surgical plan for total hip replacement
• Signing of consent form to participate in the study

Exclusion criteria

• Patient refusal
• BMI > 40 kg/m2
• Surgical plan for revision of hip replacement
• Patient unable to quantify pain level
• Chronic kidney disease with a Glomerular Filtration Rate < 50ml/min
• Previously medicated with opioids
• Patient unable to perform the surgery with spinal block
• Allergy to local anesthetics
• Infection in the site of the Erector Spinae Plane or Fascia Iliaca block
• Allergy or contraindication to the use of morphine

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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0 participants in 3 patient groups

Control-group

No Intervention group

Description:

No peripheral nerve block

Single-shot erector spinae plane block

Experimental group

Description:

The patient is positioned in lateral decubitus. The anesthesiologist uses a linear high-frequency probe in a longitudinal direction laterally to the mid-sagittal plane at the level of L4 until the transverse process is identified and, more superficial, the erector spinae muscle. A 22G needle of 80mm is introduced in-plane craniocaudally towards the transverse process of L4 until its tip is in the plane deep to the erector spinae muscle. Single-shot block with 30ml of ropivacaine 0,5% + adrenaline 100mcg

Treatment:

Procedure: Single-shot erector spinae plane block

Single-shot fascia iliaca block

Active Comparator group

Description:

The patient is positioned in dorsal decubitus. The anesthesiologist uses a linear high-frequency probe in a transversal direction, below the crural arch so as to identify the femoral artery. Afterwards the probe is moved laterally to find the iliac muscle and its fascia. A 22G needle of 80mm is introduced in-plane latero-medially until its tip is below the fascia iliaca (between the muscle and its fascia). Single-shot block with 40ml of ropivacaine 0,2%.

Treatment:

Procedure: Single-shot fascia iliaca block