Lumbar Erector Spinae Plane Block and Fascia Iliaca Compartment Block After Total Hip Arthroplasty

Study Overview
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Brief Summary
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Compare the analgesic efficacy of ultrasound-guided lumbar erector spinae plane block (L-ESPB) versus fascia iliaca compartment block (FICB) in patients scheduled for total hip arthroplasty.

Detailed Description
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Ultrasound-guided erector spinae plane (ESP) block is a recent regional anesthetic technique. It was first described by Forero et al. in 2016 for acute and chronic thoracic pain management. Local anesthetic (LA) is injected between the erector spinae muscle and the vertebra's transverse process, leading to the spread of LA cephalad, caudally, and through the paravertebral space.

Official Title
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Comparative Study Between Ultrasound-Guided Lumbar Erector Spinae Plane Block and Fascia Iliaca Compartment Block for Postoperative Analgesia After Total Hip Arthroplasty

Conditions
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Analgesia

Intervention / Treatment
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* Drug: Lumbar Erector spinae plane block (L-ESPB)
* Drug: Fascia iliaca compartment block (FICB)
* Drug: spinal anesthesia plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 30-75 years from both sexes. ASA I-III scheduled for unilateral hip surgery under spinal anesthesia. Exclusion Criteria: Patients' refusal. Patients who were unable to co-operate with researchers. History of allergy to local anesthetics. Local infection at the site of the block. Patients with bleeding and coagulation disorders. Patients with renal, hepatic, cardiac decompensation, or spine deformities. Patients receiving opioids for chronic analgesic therapy Body mass index > 35 kg/m2

Ages Eligible for Study
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Minimum Age: 30 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: Control Group<br>Patients will receive spinal anesthesia alone (30 ml bupivacaine 0. 25%). | Drug: spinal anesthesia plane block<br>* Patients will receive spinal anesthesia alone<br>|
| Active Comparator: Lumbar Erector spinae plane block (L-ESPB)<br>Patients will receive spinal anesthesia and then ipsilateral lumbar erector spinae plane block (30 ml bupivacaine 0. 25%) at the level of the lumbar region in the operating room after the end of the surgery. | Drug: Lumbar Erector spinae plane block (L-ESPB)<br>* The fourth lumbar vertebral level will be determined using the conventional method (the imaginary line between two crista iliacas). The convex transducer will be placed at the mid-vertebral line in the sagittal plane. The transducer will be shifted from the midline, 3.5-4 cm laterally, to the side of the surgery to visualize the erector spinae muscle and transverse process. Using the out-of-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthesia solution (30 ml bupivacaine 0.25%) will be administered, leading to hydro dissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurred when administering local anesthesia. All local anesthesia will be administered to this location between the transverse process and the erector spinae muscle<br>|
| Active Comparator: Fascia iliaca compartment block (FICB)<br>Patients will receive spinal anesthesia and then ipsilateral suprainguinal fascia iliaca compartment block (30 ml bupivacaine 0. 25%) in the operating room after the end of the surgery. | Drug: Fascia iliaca compartment block (FICB)<br>* The transducer will be placed laterally to the femoral nerve. It then rotated 90 degrees to the sagittal plane, under ultrasound guidance, a regional block needle (22 G, 80 mm) will be introduced in the cranial direction. Once good needle alignment with the ultrasound beam is achieved, the needle will be inserted deep into the tissues until an optimal position of the needle tip is obtained. Needle location will be additionally verified by injecting 0.5-1 ml of the prepared local anesthesia solution and observing the solution spread within the tissues. Once the correct position of the needle tip is confirmed, the local anesthetic will be deposited under the iliac fascia to force its flow towards the lumbar plexus. 30 ml of bupivacaine 0.25% solution will be used for the block. local anesthesia will be administered as 5 mL boluses with a 20 second interval.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of postoperative pain | Assessment of postoperative pain using the Numeric rating scale (NRS), NRS is a valid and simple approach to pain assessment (0= no pain and 10= worst possible pain) | UP to 24 hour postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time required for the first rescue analgesia. | Morphine sulfate 0.03 mg/kg will be administered intravenous as a rescue analgesic if Numeric rating scale is ≥ 4 | Up to 24 hours postoperatively | 
| The total postoperative rescue analgesic | The total amount of morphine consumption | first 24 hours postoperatively | 
| Adverse effects | Any complications or undesirable side effects will be observed and treated. | Up to 24 hours postoperatively |