ESPB vs FICB for Pain Management Following Total Hip Prosthesis Surgery
Condition: Knee Osteoarthritis; Knee Disease; Knee Arthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Hip arthroplasty surgery is frequently performed on elderly patients in the community and it
      is associated with long-term postoperative hospital stays and high mortality.

      Postoperative pain management is a multimodal process that includes intravenous and regional
      anesthesia methods. The ultrasound(US) guided erector spinae plane block (ESPB) is injected
      with a local anesthetic into the deep fascia of the erector spinae. In the literature, it has
      been reported that ESPB provides effective analgesia after a hip surgery. The fascia iliaca
      compartment block (FICB) is a safe method used for postoperative analgesia following hip,
      femoral, and knee surgeries.

      The aim of this study is to compare US-guided FICB and ESPB for postoperative analgesia
      management after total hip prosthesis surgery.
    

Detailed description: 
      Hip arthroplasty surgery is frequently performed on elderly patients in the community and it
      is associated with long-term postoperative hospital stays and high mortality. Severe
      postoperative pain may further reduce the limited cardiopulmonary capacity, especially in the
      elderly population. Postoperative effective pain treatment provides early mobilization and
      shorter hospital stay, thus complications due to hospitalization such as infection and
      thromboembolism may be reduced.

      Postoperative pain management is a multimodal process that includes intravenous and regional
      anesthesia methods. Parenteral opioids are generally preferred in the management of acute
      postoperative pain. However, opioids have undesired adverse events such as nausea, vomiting,
      itching, sedation, and respiratory depression (opioid-related adverse events). Regional
      anesthesia techniques are frequently preferred as a part of multimodal analgesia in hip
      surgeries. Various methods may be performed to reduce the use of systemic opioids and for
      effective pain treatment. US-guided interfascial plane blocks have been used increasingly due
      to the advantages of ultrasound in anesthesia practice.

      The ultrasound(US) guided erector spinae plane block (ESPB) is injected with a local
      anesthetic into the deep fascia of the erector spinae. Visualization of sonoanatomy with the
      US is simple and the spread of local anesthetic solution can be seen easily in the deep
      fascia of the erector spinae. Visualization of sonoanatomy in the US is easy, and the spread
      of local anesthetic agents can be easily seen under the erector spinae muscle. Thus,
      analgesia occurs in several dermatomes with cephalad-caudad way. Cadaveric studies have shown
      that the injection spreads to the ventral and dorsal roots of the spinal nerves. In the
      literature, it has been reported that ESPB provides effective analgesia after a hip surgery.
      The fascia iliaca compartment block (FICB) is a safe method used for postoperative analgesia
      following hip, femoral, and knee surgeries.

      The aim of this study is to compare US-guided FICB and ESPB for postoperative analgesia
      management after total hip prosthesis surgery. The primary aim is to compare perioperative
      and postoperative opioid consumption and the secondary aim is to evaluate postoperative pain
      scores (VAS), and adverse effects related to opioids (allergic reaction, nausea, vomiting).
    

Intervention name(s): Postoperative analgesia management
Intervention type(s): Drug
Intervention description(s): Intravenous paracetamol 1 gr and a dose of 0,5 mg/kg-1 tramadol intravenously will be performed on all patients 30 min before the end of the surgery for postoperative analgesia. Patients will be administered paracetamol 1 gr IV every 8 hours in the postoperative period. A patient-controlled device prepared with 5 mg/ ml tramadol will be attached to all patients with a protocol including 10 mg bolus without infusion dose, 10 min lockout time, and 4-hour limit. If the VAS score will be ≥ 4, 0,5 mg/kg-1 meperidine IV will be administered.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There are two models for this study. Fascia iliaca compartment block (FICB) group, and Erector spinae plane block (ESPB) group
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Total hip prosthesis surgery; Postoperative analgesia; Erector spina plan block; Fascia iliaca compartment block