Ultrasound-guided Suprainguinal Fascia Iliaca Compartment Block for Analgesia After Total Hip Arthroplasty
Condition: Arthritis of Hip
MeSH terms: Arthritis
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      Total hip replacement (THR) is a common and major surgical procedure performed in elderly
      patients with significant comorbidities. Optimizing a patient's anesthetic and analgesic
      modalities could play a significant role in minimizing the risk of adverse events in the
      perioperative period and potentially shorten time to discharge and recovery.

      Establishing a safe and effective post-operative analgesic plan is of central importance to
      successful THR anesthesia care. The application of ultrasound visualization has improved the
      efficacy of the fascia iliaca compartment block (FICB). However, ultrasound-guided
      suprainguinal FICB has not yet been evaluated clinically in a large trial as a method of
      providing post-operative analgesia following THR.

      The investigators hypothesize that by performing the suprainguinal fascia iliaca block with
      ultrasound, it will be possible to achieve superior and more reliable analgesia in the first
      24 hours than without a block.
    

Detailed description: 
      The search for the optimal pain treatment strategies is a work in progress. As techniques and
      technology evolve so should our approach for the best analgesic regimen that would minimize
      unwanted side effects and potential risk and more importantly improve patient satisfaction.

      The literature has supported the use of peripheral nerve blocks for analgesia as well as
      improved functional outcome after total knee arthroplasty. The addition of peripheral nerve
      blocks for THR has been more controversial, as the only effective nerve block, the posterior
      approach to the lumbar plexus, is an advanced regional technique with potential for serious
      complications. The application of ultrasound visualization has improved the efficacy of the
      infrainguinal fascia iliaca block. However, ultrasound guided suprainguinal fascia iliaca
      block has not yet been evaluated clinically in a large trial as a method of providing
      post-operative analgesia following primary hip arthroplasty.

      The investigators hypothesize that by performing the suprainguinal fascia iliaca block with
      ultrasound, it will be possible to achieve superior and more reliable analgesia than that
      obtained using the landmark "2-pop" technique and the infrainguinal blocks.

      The aim of this study is to assess whether the ultrasound guided suprainguinal fascia iliaca
      block can provide superior early postoperative analgesia in patients undergoing primary hip
      arthroplasty, and minimizing the pain immediately after the resolution of the spinal
      anesthetic.

      The investigators propose to perform the first triple-blinded RCT examining the early
      analgesic efficacy of ultrasound-guided suprainguinal FICB after THR (lateral approach) under
      spinal anesthesia.
    

Intervention name(s): 0.5% Ropivacaine; Normal saline
Intervention type(s): Drug; Drug
Intervention description(s): Ultrasound-guided suprainguinal fascia iliaca compartment block with 40mls 0.5% ropivacaine.; Ultrasound-guided suprainguinal fascia iliaca compartment block with 40mls normal saline.
Other intervention name(s): Naropin
Intervention MeSH terms: Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Fascia Iliaca Block; Total Hip Arthroplasty; Total Hip Replacement; Ultrasound