USFIB at the Inguinal Ligament for Total Hip Arthroplasty
Condition: Post Surgical Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Hip replacement surgery is one of the most common elective surgeries in Canada and with this
      surgery, there is considerable pain after the operation. By decreasing the amount of pain
      after surgery, the patients may be able to move and walk quicker, resulting in easier
      physiotherapy sessions, shorter hospital stays and may help to avoid adverse outcomes like
      nausea and vomiting and being overly sedated. By using ultrasound guided femoral nerve block,
      it may be an alternative for pain management with minimal side effects for patients having
      hip replacement surgery.
    

Detailed description: 
      Ultrasound guided femoral blocks have been studied since the late 90's. A study published in
      1997 by Marhofer et al. pointed that ultrasound guidance in a 3-in-1 block (femoral,
      obturator, lateral cutaneous nerves), improved the quality of the sensory block and reduced
      the onset time when compared with a nerve-stimulation technique in patients undergoing hip
      surgery after trauma.(13) In a meta-analysis comparing ultrasound guidance versus electrical
      nerve-stimulation for peripheral nerve blocks, the authors reported a decreased risk of block
      failure, shorter procedure time and faster onset time when ultrasound is used.(14)

      A systematic review studying the outcomes after Total Hip Arthroplasty concluded that when
      compared with systemic analgesia the use of femoral nerve block was on unclear benefit.(15)
      Separate analysis of the two studies included showed that in the Biboulet study, ultrasound
      was not used to perform the blocks, and pain with activity was not evaluated in the first 24
      hours after surgery, time in which the maximum benefit of blocks is observed.(16) In the
      second study by Singelyn et al. with continuous femoral nerve block, the authors found
      similar pain relief than with IV Patient Controlled Analgesia morphine with fewer side
      effects.(17)

      While recent publications have demonstrated the analgesia effectiveness of femoral nerve
      block and fascia iliaca block for hip fractures,(18) there are not references in the
      literature analyzing the effectiveness of a single shot, ultrasound-guided, femoral nerve
      block in primary hip arthroplasty. This fact opens up the possibility to continue researching
      the analgesic effectiveness of this block in a population where the options for handling
      postoperative pain are limited widely for its side effects together with the use of
      anticoagulant and anti-thrombotic therapy.

      This technique is considered a simple procedure, easy to teach and to learn. If our study
      shows improvement of the outcomes, it will feasible to incorporate this block as an
      alternative for pain management after primary hip arthroplasty.

      Given the complexity of this proposed randomized-controlled trial, a pilot study was deemed
      necessary to find out the feasibility and safety of the intervention, rate of patient
      recruitment and needs for additional personnel.
    

Intervention name(s): Single shot femoral nerve block
Intervention type(s): Drug
Intervention description(s): Nerve block in lingual crease using ultrasound guidance
Other intervention name(s): Femoral Nerve Block with 40ml bupivacaine plus 0.5% epinephrine
Intervention MeSH terms: Epinephrine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: femoral nerve block; ultrasound guided; total hip arthroplasty