Ultrasound Guided Quadratus Lumborum Block for Post Operative Analgesia After Hip Arthroplasty

Study Overview
=================
Brief Summary
-----------------
The study evaluates the effectiveness of anterior quadratus lumborum block for post operative analgesia after hip arthroplasty. Half of the participants will receive ultrasound guided anterior quadratus lumborum block using 30ml bupivacaine 0.375%, while the other half will not receive the block ( control group).

Detailed Description
-----------------
Sensory innervation of the hip region involves branches of the lumbar plexus and sacral plexus. Effective post operative analgesia can be approached by blocking the lumbar plexus at the level of the quadratus lumborum muscle. Quadratus lumborum block has several approach methods (anterior, lateral, posterior, and intramuscular). Anterior quadratus lumborum block also known as transmuscular QL block or QL3, the local anaesthetic (30ml of bupivacaine 0.375%) is injected between the psoas major muscle (PM) and the quadratus lumborum muscle (QL). Therefore, the anterior quadratus lumborum block may generate analgesia from T10 to L4 covering the sensory innervation of the hip region.

Official Title
-----------------
Randomized, Controlled, Double Blind Trial of Ultrasound Guided Quadratus Lumborum Block for Post Operative Analgesia After Hip Arthroplasty

Conditions
-----------------
Pain, Postoperative

Intervention / Treatment
-----------------
* Procedure: Anterior Quadratus lamborum block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: American society of anesthesiologists physical status |-||| , scheduled to undergo unilateral hip replacement via lateral approach. Exclusion Criteria: patient refusal. History of neurological/neuromuscular, psychiatric, dementia preventing proper comprehension. coagulation disorders. History of allergy to the study medication. Infection overlying the injection site.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Adult 90 orthopaedic patient ASA physical status |-||| will be randomly allocated in two groups each one 45 patients, one group will receive the anterior quadratus lumborum block and the other group will not receive the block.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: QL group<br>Anterior Quadratus lumborum block will be done for all patients of these group. Local anaesthetic (30ml of bupivacaine) will be injected in fascial plane between the quadratus lumborum muscle and Psoas major muscle by using the ultrasound. | Procedure: Anterior Quadratus lamborum block<br>* Local anaesthetic will be injected in the fascial plane between psoas major muscle and quadratus lumborum muscle.<br>* Other names: QL3;|
| No Intervention: C group<br>Patients of these group will be the control group. The will receive acetaminophen 1g every 8h, ketorolac 30mg ever 12h and as required morphine 2mg for post operative analgesia after hip arthroplasty. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity assessment | Patients will be trained to use visual analogue scale which consists of 10cm line, 0 cm equivalent to no pain and 10 cm denoting the worst imaginable pain. | every hour for the first 4 post operative hours and then every 4 hours for the rest of the 24 post operative hours. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total amount of post operative morphine (mg). | Total amount of post operative morphine (mg) used as rescue analgesia and the first time of its request. | any time in the first 24 post operative hours. |