LPB Combined With QLB Using Single-needle Technique (LPQLB-SNT) for Hip Arthroplasty

Study Overview
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Brief Summary
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Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to effectively relieve pain and restore function in patients with hip osteoarthritis, osteonecrosis of femoral head and hip fracture.The Lumbar Plexus Block (LPB) is currently used as the standard regional anesthesia technique to provide postoperative pain management after THA. The lumbar plexus (LP) originates from T12 to L5. In general, multiple-needle nerve blockade procedure is needed to block different branches of LP. Therefore, we need more time to finish the regional anethesia procedure and it's not easy for an inexperienced anesthesiologist to master the technique absolutely. In addition, multiple injections will increase the discomfort of the patients. We aim to investigate the effects of lumbar plexus combined with quadratus lumborum block using single-needle technique with Shamrock method as an alternative regional anesthesia.

Official Title
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Ultrasound-guided Lumbar Plexus Combined With Quadratus Lumborum Block Using Single-needle Technique With Shamrock Method for Hip Arthroplasty

Conditions
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Hip Osteoarthritis, Anesthesia, Local, Hip Fractures, Osteonecrosis of Femoral Head

Intervention / Treatment
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* Procedure: L3 LPB
* Procedure: L4 LPB
* Procedure: T12 block
* Procedure: L3 QLB
* Drug: 0.375%ropivacaine 25 ml (Raropin)
* Drug: 0.375%ropivacaine 40 ml (Raropin)
* Procedure: General anesthesia with tracheal intubation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Body mass index (BMI) between 18.5 and 30kg/m2 and the weight ≥50kg American Society of Anesthesiologists (ASA) classification I-II Postero-lateral operative incision approach unilateral hip arthroplasty Aged 18-75 Exclusion Criteria: Patient refusal Patients with coagulopathy or on therapeutic anticoagulation Pregnancy Multiple trauma Hypersensitivity or allergy to ropivacaine History of ankylosing spondylitis or spinal surgery Lower extremity neuropathy Unable to communicate

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: L3 LPB technique (P group)<br>ultrasound-guided shamrock approach L3 lumbar plexus block with single-needle technique | Procedure: L3 LPB<br>* ultrasound-guided L3 lumbar plexus block<br>Drug: 0.375%ropivacaine 25 ml (Raropin)<br>* 0.375%ropivacaine (Raropin) 25ml will be given<br>Procedure: General anesthesia with tracheal intubation<br>* General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation<br>|
| Active Comparator: T12 combined with L3 and L4 LPB technique (TP group)<br>ultrasound-guided posterior approach thoracic 12 combined with L3 and L4 lumbar plexus block with mulitple-needle technique | Procedure: L3 LPB<br>* ultrasound-guided L3 lumbar plexus block<br>Procedure: L4 LPB<br>* ultrasound-guided L4 lumbar plexus block<br>Procedure: T12 block<br>* ultrasound-guided thoracic 12th segment nerve block<br>Drug: 0.375%ropivacaine 40 ml (Raropin)<br>* 0.375%ropivacaine (Raropin) 40ml will be given<br>Procedure: General anesthesia with tracheal intubation<br>* General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation<br>|
| Experimental: L3 LPB combined with QLB (LPQLB-SNT, PQ group)<br>ultrasound-guided shamrock approach L3 lumbar plexus block combined with quadratus lumborum block with single-needle technique | Procedure: L3 LPB<br>* ultrasound-guided L3 lumbar plexus block<br>Procedure: L3 QLB<br>* ultrasound-guided quadratus lumborum block at L3 level<br>Drug: 0.375%ropivacaine 40 ml (Raropin)<br>* 0.375%ropivacaine (Raropin) 40ml will be given<br>Procedure: General anesthesia with tracheal intubation<br>* General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sensory block assessment | The sensory block will be assessed by cold alcohol swab and pinprick at lateral, anterior and medial areas of thigh and postero-lateral area of gluteus using a 0 to 2 point scale. 0= no block, patients can feel cold; 1= analgesic block, patient can feel touch but not cold; 2= anesthetic block, patient cannot feel cold or touch. | 30 minutes after nerve block procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative static pain at timepoint 1 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 30mins after the patient recover from general anesthesia | 
| postoperative static pain at timepoint 2 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 6 hours after surgery | 
| postoperative static pain at timepoint 3 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 12 hours after surgery | 
| postoperative static pain at timepoint 4 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 24 hours after surgery | 
| Performance time of block | Performance time is defined as the time from insertion of the block needle (skin puncture) until finishing local anaesthetic (LA) injection | During nerve block procedure | 
| intraoperative sufentanil dosage | The total intraoperative sufentanil dosage will be recorded | during the operation | 
| Incidence of block related adverse events | Intraoperative and postoperative adverse events such as vascular puncture, local anesthetic systemic toxicity, epidural spread, etc. | within 24hours after nerve block procedure | 
| Cumulative doses of intraoperative vasoactive medications | Cumulative doses of intraoperative vasoactive medications (urapidil, atropine, ephedrine and deoxyepinephrine, etc.) | during the operation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lumbar plexus block, quadratus lumorum block, total hip arthroplasty, single-needle, shamrock approach