Lumbar Plexus Block Versus Quadratus Lumborum Block for Primary Anterior Total Hip Arthroplasty
Condition: Osteoarthritis; Total Hip Arthroplasty
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to
      effectively relieve pain and restore function in patients with end stage osteoarthritis. In
      an attempt to accelerate recovery many orthopedic surgeons have opted to utilize a direct
      anterior approach (DAA) as opposed to the more traditional posterolateral approach (PLA). The
      literature supports that DAA is superior to PLA with regard to lower blood loss, less pain,
      shorter hospital stay, and faster rehabilitation. Traditionally the study team has performed
      Lumbar Plexus blocks (LPB) to provide post-operative analgesia for total hip arthroplasty.
      The quadratus lumborum block (QLB) is a newer regional analgesic technique that may be as
      effective as LPB at providing pain control following DAA hip arthroplasty. This study is
      designed to compare the efficacy, with regards to post-operative pain management, between LPB
      and QLB following a DAA total hip arthroplasty.
    

Detailed description: 
      In an attempt to accelerate recovery many orthopedic surgeons have opted to utilize a direct
      anterior approach (DAA) as opposed to the more traditional posterolateral approach (PLA) in
      regards to total hip arthroplasty (THA). The DAA technique involves dissection of muscular
      planes for insertion of components resulting in less tissue damage as compared to PLA.
      Traditionally the study team has performed Lumbar Plexus blocks (LPB) to provide
      post-operative analgesia for total hip arthroplasty. This technique works well for the
      traditionally performed PLA in that the hip joint and incision site are within the analgesic
      distribution of the LPB. Conversely, the DAA utilizes an anterior incision that overlies the
      L1 and L2 dermatomes as opposed to the lower lumbar dermatomes of the PLA incision. When
      performing LPB it has been the study team's clinical experience that it is rare to achieve
      analgesia in the proximal distribution of the lumbar plexus resulting in apparent sparing of
      the L1 and L2 nerve root distributions. The quadratus lumborum block (QLB) is a newer
      regional analgesic technique that may be as effective as LPB at providing pain control
      following DAA hip arthroplasty. The QLB is thought to provide analgesia by blocking both the
      lateral and anterior cutaneous branches of T7 through L4. This degree of dermatomal coverage
      suggests that QLB could be an efficacious alternative to LPB for DAA hip arthroplasty. It is
      hypothesized that the QLB will provide equivalent analgesia when compared to the LPB as
      determined by a comparison of verbal reported pain scores.
    

Intervention name(s): LPB; QLB
Intervention type(s): Other; Other
Intervention description(s): The LPB will be performed in a lateral position, but modified to utilize ultrasound guidance to enhance our ability to quickly and safely locate the lumbar plexus as well as to avoid unblinding with regard to the traditional landmark LPB technique. For both LPB and QLB a TOTAL DOSE of 20 cc of the following local anesthetic mixture will be administered: Ropivacaine 0.2% and Epinephrine - 2.5 mcg/cc (1:400,000 concentration).; The QLB will be performed in a lateral position in a manner consistent with the technique first described by Børglum. For both LPB and QLB a TOTAL DOSE of 20 cc of the following local anesthetic mixture will be administered: Ropivacaine 0.2% and Epinephrine - 2.5 mcg/cc (1:400,000 concentration).
Other intervention name(s): Lumbar Plexus Block; Quadratus Lumborum Block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care
Keywords: Lumbar Plexus Block; Quadratus Lumborum Block; Direct Anterior Approach; Post-Operative; Pain Management