Fascia Iliaca Versus Quadratus Lumborum Block for Pain Management in Total Hip Replacement.

Study Overview
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Brief Summary
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Postoperative analgesia is essential for early ambulation of patients with hip arthroplasties as well as decreasing hospital stay time. Fascial plane blocks are emerging as a gold standard for postoperative analgesia instead of opioids and NSAIDs, with all there side effects. The investigators aim to compare postoperative pain levels and opioid analgesic needs of fascia iliaca block versus quadratus lumborum block in patients undergoing primary total hip arthroplasty under general anesthesia.

Official Title
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Fascia Iliaca Versus Quadratus Lumborum Block for Postoperative Pain Management in Total Hip Replacement: A Comparative Prospective Randomized Study

Conditions
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Postoperative Opioid Requirements in Patients With Traumatic Fracture Hip

Intervention / Treatment
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* Procedure: Fascia Iliaca block
* Procedure: Quadratus lumborum block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients aging between 40-60 years ASA II, III with no known hypersensitivity for local anesthetics Exclusion Criteria: Patient refusal Known allergy to local anesthetics Previous femoral artery surgery Local infection at the site of injection Those on anticoagulation therapy

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Fascia iliaca block for postoperative pain management in hip arthroplasty<br> | Procedure: Fascia Iliaca block<br>* Ultrasound guided fascia iliaca block done by palpation of anterior superior iliac spine to identify the inguinal crease, then place the ultrasound probe on it to identify the sartorius muscle. Sonographic anatomy will be identified, from superficial to deep, consisting of subcutaneous fat, the internal oblique muscle, the transverse abdominis muscle, the fascia iliaca covering the iliacus muscle and the iliacus muscle itself. The block needle will be advanced in out-of plane to puncture the fascia iliaca. With the needle tip just below the fascia iliaca, 2 ml of a local anesthetic will be injected to confirm the tip location. Once the proper position is confirmed, 40 ml of bupivacaine 0.25% will be injected superficial to the iliacus muscle and deep to the fascia iliaca.<br>|
| Active Comparator: Quadratus lumborum block for postoperative pain management in hip arthroplasty<br> | Procedure: Quadratus lumborum block<br>* The patients will receive anterior ultrasound guided quadratus lumborum block QLB in the lateral position. The transducer will be first placed in a parasagittal orientation 3-4 cm lateral to the midline and over the sacrum to identify the L5 transverse process. The probe will then rotated into a transverse orientation with slight medial and caudal angulation to obtain a transverse oblique view at L5 transverse process .The ultrasound probe will be tilted , so the lateral end of the probe will be more cranial than the medial side of the probe to avoid the acoustic shadow of the iliac crest. Identify the quadratus lumborum and psoas major and inject the local anesthetic above the QL<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of postoperative analgesia | The investigators will measure the time to first analgesic request after giving the block | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total rescue analgesic requirements | Measuring the total rescue analgesic requirement in the postoperative period | 24 hours | 
| Functional recovery | Will be assessed by duration of hospital stay | 72 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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opioid requirements