Lumbar ESPB in Hip Replacement Surgery

Summary

In this study, continuous erector spinae plane block (ESPB) will be compared to continuous epidural analgesia in patients undergoing elective hip replacement surgery. Opioid consumption, pain severity, quadriceps femoris muscle strength, ability to walk, and quality of recovery will be evaluated. Moreover, chronic pain severity in months after the hospital discharge will be assessed.

Conditions

• Coxarthrosis
• Pain, Postoperative
• Pain, Acute
• Pain, Chronic
• Postoperative Pain, Chronic
• Analgesia
• Quality of Life
• Anesthesia
• Spinal

Interventions

PROCEDURE

Spinal anesthesia

Before the beginning of surgery, all patients will be anesthetized with 0.5 % hyperbaric bupivacaine (Marcaine Heavy), 1.5 - 2.5 mL solution. A pencil point spinal needle will be used.

PROCEDURE

lumbar erector spinae plane block

Investigators will perform the lumbar ESPB under ultrasound control at the L3 level on the ipsilateral site of the surgery. After dissection with 0.9 NaCl, we will leave a catheter in the ESP. Then, we used 0.25% bupivacaine with epinephrine (5mcg/mL), 0.4 mL per kg, up to 40 mL.

PROCEDURE

Epidural analgesia

After identifying the epidural space and spinal anesthesia (combined technique), a catheter will be placed in the epidural space. Investigators will give an epidural catheter a test dose of 2% lidocaine (2 mL). At the end of the surgery, the patient will receive 5 mL of a mixture containing 0.1% bupivacaine with fentanyl (2 mcg/mL).

PROCEDURE

patient-controlled analgesia

Each participant will receive a pump with oxycodone (1mg/ml) using a patient-controlled analgesia (PCA) technique, a bolus of 1 mL, and a lockout of 5 minutes for the first postoperative day.

DIAGNOSTIC_TEST

Timed Up and Go test

Investigators will measure the time the patient took to rise from a chair, walk three meters, turn around 180 degrees, walk back to the chair, and sit down while rotating 180 degrees. We will assess the patient before the surgery and 24 and 48 hours after hip replacement.

DIAGNOSTIC_TEST

neuropathic pain symptom inventory

The Neuropathic Pain Symptom Inventory (0-100; 0 denotes no pain, 100 the most severe pain) will be evaluated before the surgery and three and six months following the procedure.

DIAGNOSTIC_TEST

Lovett test

A physiotherapist will use the six-grade Lovett scale to measure muscle strength, in which 0 denotes no muscle contractility, and 5 denotes the complete range of motion against gravity, with full resistance. We will test this before the surgery, 24 and 48 hours after the operation.

DIAGNOSTIC_TEST

Visual analog scale

Investigators will measure pain intensity with VAS (0-10; 0 denotes no pain, 10 maximal pain) before and after the surgery. Pain will be evaluated at rest and upon the activity.

DIAGNOSTIC_TEST

Quality of Recovery 40

Investigators will assess the quality of recovery with QoR-40 a day after the surgery, a month, and three months following the procedure. The minimal score is 40, and the maximal is 200. The higher the result, the better the quality of recovery is.

DIAGNOSTIC_TEST

Ability to sit, stand upright, and walk

A physiotherapist will evaluate the patient's ability to sit, stand upright, and walk at planned times.

Sponsors & Collaborators

• Medical University of Lublin

  lead OTHER

Principal Investigators

• Paweł Piwowarczyk, M.D., Ph.D. · Medical University of Lublin

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

100 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-02-19

Primary Completion

2025-02-01

Completion

2025-08-01

Countries

• Poland

Study Locations