Ultrasound Guided Fascia Iliaca Block for Pain Control After Elective Hip Replacement Surgery

University of Saskatchewan

Status: Completed

Conditions: Arthroplasty, Replacement, Hip; Fascia Iliaca Block

Treatments: Drug: Saline; Drug: .2% Ropivacaine; Procedure: Fascia Iliaca Block

Study type: Interventional

Funder types: Other

Identifiers

NCT02108847

Bio 13-314

Details and patient eligibility

About

The purpose of this study is to determine whether ultrasound guided fascia iliaca blocks performed before surgery help to reduce pain after elective total hip replacements.

Full description

Total hip arthroplasty is associated with moderate to severe pain in the acute postoperative period, which can increase the risk of postoperative complications such as thromboembolism, myocardial ischemia/infarction, pneumonia, poor wound healing, insomnia, and delirium.

Sensory innervation of the hip joint comes from a combination of peripheral nerves, including femoral, obturator, sciatic, superior gluteal, and nerve for the quadratus femoris muscle. Superficial innervation of the skin involved in incision for hip arthroplasty comes from the lateral femoral cutaneous nerve (LFCN).

The fascia iliaca block (FIB) was originally described in 1989 using a landmark technique. The ultrasound guided FIB was introduced in recent years, and has been shown to produce a better quality of block than the landmark technique. It appears to consistently block the femoral and LFCN, while being less successful in achieving consistent obturator blockade.

The FIB is effective for analgesia for hip fracture injuries in the emergency department. Thus far, there has been limited exploration into the potential use of this block as a tool for postoperative analgesia after elective hip arthroplasty. The potential benefits of this regional block, as with other regional techniques, include better analgesia, less opioid use and associated side effects, and an improved overall patient satisfaction with postoperative recovery.

Enrollment: 42 patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists' (ASA) score I, II or III
• Scheduled for elective total hip arthroplasty

Exclusion criteria

• Contraindication to regional anesthesia (allergy to local anesthetic, coagulopathy, infection or malignancy in the area)
• Neurologic disorder affecting the ability to sense pain
• Long term opioid use or chronic pain disorder
• History of drug or alcohol abuse
• Patient refusal
• Pregnancy
• Revision procedures
• General anesthetic
• Psychiatric or mental conditions that may affect assessment of outcomes

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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42 participants in 2 patient groups

Fascia Iliaca Block - Ropivacaine

Experimental group

Description:

Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of 0.2% ropivacaine.

Treatment:

Drug: .2% Ropivacaine

Procedure: Fascia Iliaca Block

Fascia Iliaca Block - Saline

Sham Comparator group

Description:

Ultrasound guided fascia iliaca block performed preoperatively with 40 mL of Saline.

Treatment:

Procedure: Fascia Iliaca Block

Drug: Saline