SFIB vs Anterior QLB in Total Hip Arthroplasty

Study Overview
=================
Brief Summary
-----------------
Quadratus lumborum block (QLB) is a facial plane block defined to provide analgesia from T7-L3 dermatomes. There are articles reporting that it is an effective analgesic method in hip surgeries. Suprainguinal fascia iliaca block (SIFIB) also blocks components of the lumbar plexus and provides effective analgesia in hip surgeries. The investigators aim to compare the effectiveness of QLB and SIFIB in patients undergoing primary total hip arthroplasty (THA).

Official Title
-----------------
Comparison of the Efficiency of Ultrasound-Guided Suprainguinal Fascia Iliaca Block and Anterior Quadratus Lumborum Block in Patients Undergoing Total Hip Arthroplasty Under Spinal Anesthesia

Conditions
-----------------
Pain

Intervention / Treatment
-----------------
* Procedure: Ultrasound Guided Suprainguinal Fascia iliaca Block
* Procedure: Ultrasound Guided Anterior Quadratus Lumborum Block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: American Society of Anesthesiologists (ASA) classification I-II-III Scheduled for total hip artroplasty surgery under spinal anesthesia Exclusion Criteria: Patients who did not want to participate in the study Patients with cognitive dysfunction who cannot evaluate the NRS score and cannot use PCA Known local anesthetics and opioid allergy, Pregnancy or lactation Patients with a contraindication to spinal and regional anesthesia Presence of multiple fractures

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Ultrasound Guided Suprainguinal Fascia iliaca Block<br>Patients randomized to receive suprainguinal fascia iliaca block | Procedure: Ultrasound Guided Suprainguinal Fascia iliaca Block<br>* Patients in this group will be administered SFIB with 50 mL of local anesthetic solution (Bupivacaine %0.25) under ultrasound guidance after the surgery is completed.<br>|
| Active Comparator: Ultrasound Guided Anterior quadratus lumborum block<br>Patients randomized to receive anterior quadratus lumborum block | Procedure: Ultrasound Guided Anterior Quadratus Lumborum Block<br>* Patients in this group will be administered anterior QLB with 40 mL of local anesthetic (Bupivacaine %0.25) under ultrasound guidance after the surgery is completed.<br>|

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cumulative opioid comsumption | Morphine consumptions for both group will be recorded | up to 24 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric rating scale for postoperative pain intensity | Changes in Numeric Rating Scale (NRS) at rest and on movement will be recorded at intervals. (3-6-12-18-24th hour) NRS is a unidimensional measure of pain intensity in adults. The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable). | up to 24 hours | 
| Quality of Recovery (QoR-15) | The impact of surgical and anesthetic interventions on perioperative quality of life and ability to resume routine life activities will be assessed using the Quality of Recovery (QoR) tool. The QoR-15 scale is a patient-based outcome measure in the form of a 15-item validated questionnaire. | at 24th hour | 
| Presence of quadriceps motor block (defined as paralysis or paresis). | Quadriceps motor function will be tested with the patient supine and with the hip and knee flexed at 45º and 90º, respectively. The subject will be asked to extend the knee first against gravity and then against resistance. Quadriceps strength will be graded according to a 3-point scale: normal strength = 0 point (extension against resistance); paresis = 1 point (extension against gravity but not against resistance); and paralysis = 2 points (no extension). | up to 24 hours | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Postoperative pain management, Total hip arthroplasty, Suprainguinal fascia iliaca block, Anterior QLB