Ultrasound-guided Fascia Iliaca Compartment Block Versus Periarticular Infiltration
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This randomized, controlled, observer-blinded study clinical trial was designed to evaluate
      ultrasound-guided fascia iliaca compartment block with ropivacaine and periarticular
      infiltration with ropivacaine for postoperative pain management after total hip arthroplasty.
    

Detailed description: 
      Despite substantial advances in our understanding of the pathophysiology of pain and
      availability of newer analgesic techniques, postoperative pain is not always effectively
      treated. Optimal pain management technique balances pain relief with concerns about safety
      and adverse effects associated with analgesic techniques. Currently, postoperative pain is
      commonly treated with systemic opioids, which are associated with numerous adverse effects
      including nausea and vomiting, dizziness, drowsiness, pruritus, urinary retention, and
      respiratory depression. Use of regional and local anesthesia has been shown to reduce opioid
      requirements and opioid-related side effects.

      Patients undergoing total hip arthroplasty (THA) (n=60) at Parkland and UT Southwestern
      Medical Center Hospitals will be randomized into one of two groups to receive either
      ultrasound-guided fascia iliaca compartment block (FICB) with ropivacaine 300 mg and 0.5 mg
      epinephrine (Group 1) or periarticular infiltration ropivacaine 300 mg and 0.5 mg epinephrine
      total (Group 2) for postoperative pain management. The remaining aspect of perioperative
      care, including the anesthetic technique (i.e., spinal anesthetic), pre- and postoperative
      care will be standardized and will be similar for all patients. The duration of the
      involvement in the study will be until 48 hours postoperatively.

      Patients in Group 1 will receive ultrasound-guided FICB after surgery. Patients in Group 2
      will receive ropivacaine via periarticular infiltration prior to closing the incision.

      The postoperative analgesia will be documented using the visual analog score (0=no pain,
      10=worst pain). In addition, total opioid dose over the 48-h study period will be documented.
      Postoperative nausea will be measured using a categorical scoring system (none=0, mild=1,
      moderate=2, severe=3) and episodes of vomiting will be documented. Rescue antiemetics will be
      given to any patient who complains of nausea and/or vomiting. All variables will be assessed
      at 2, 6, 12, 24, and 48 hours, postoperatively by an investigator blinded to group
      allocation.
    

Intervention name(s): Ropivacaine; Epinephrine
Intervention type(s): Drug; Drug
Intervention description(s): Ropivacaine 300 mg and 0.5 mg epinephrine diluted to 60 mL; 0.5 mg epinephrine
Other intervention name(s): Adrenaline
Intervention MeSH terms: Epinephrine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Nerve block; Periarticular infiltration; Ropivacaine; Pain