Circum-Psoas Blocks Versus Combined Lumbar and Sacral Plexus Blocks in Hip Fracture Surgery
ConditionHip Fractures
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age60+
SponsorZagazig University
About this trial
Hip fracture (HF) is one of the major worldwide problems that constitute a significant mortality rate, ranging from 14- 36% in the first year after injury, and is associated with profound temporary and sometimes permanent impairment of independence and quality of life in the geriatric population. Surgical treatment is considered the best option for patients with hip fractures,s especially in the elderly, however, it is associated with moderate to severe postoperative pain.
Pain is one of the main factors limiting ambulation, increasing the risk of thromboembolism by immobility and causing metabolic changes that affect other systems. Therefore, individualized pain management with the use of appropriate analgesic techniques is of paramount importance. Moreover, early intervention of rehabilitation aiming at a better postoperative recovery may reduce the length of hospital stay and return to daily. Effective pain management is one of the crucial components in enhanced recovery after surgery (ERAS).
• Numerous regional anesthetic techniques have been used to provide analgesia following hip fracture surgery, including intrathecal morphine, epidural analgesia, fascia iliaca block, lumber plexus block, and sacral plexus block, however, each of these techniques has specific limitations that prevent them from being the analgesic technique of choice for hip fracture surgery.
To our knowledge, there is no study done to compare circum-psoas block versus the combined lumbar and sacral plexus blocks as pre-emptive analgesia in patients undergoing hip fracture surgery under general anesthesia.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patient acceptance.
BMI ≤ 30 kg/m2
ASA I-III.
First unilateral surgery for hip fracture including femoral neck, intertrochanteric or subtrochanteric fracture.
Disqualifiers
Multiple trauma, multiple fractures, or pathological fractures
Prosthetic fracture or usage of bone-cement fixation in the surgery.
Scheduled for bilateral hip fracture surgery.
Pre-existing neurological deficit in the lower extremity
Trial design
Design model
Parallel
Treatments tested in this trial
control
Other interventionpatients will receive standard general anesthesia
LSP
Procedure/Surgerypatients will receive standard general anesthesia followed by ultrasound-guided combined lumbar and sacral plexus blocks with 40 ml of bupivacaine 0.25%.
CP
Procedure/Surgerypatients will receive standard general anesthesia followed by ultrasound-guided circum-psoas blocks with 40 ml of bupivacaine 0.25%.
Ultrasound
Deviceultrasound
Treatment groups
63 Participants
are divided into 3 treatment groupsGroup A: control groupPlacebo comparator 1 intervention
Group B: LSP group (lumbar and sacral plexus block)Active comparator 2 interventions
Group C: CP group (circum-psoas block)Active comparator 2 interventions
Trial outcomes
Primary outcomes
1
Assess change of Visual analogue scale (VAS)
On a scale of 0-10, the patient will learn to quantify postoperative pain where 0= No pain and 10= Maximum worst pain
Time frame
at 30 minutes, 2 hours, 4, 6,12, 24 hours postoperativelySecondary outcomes
1
Assess sensory block levels
by using alteration of pinprick sensation compared to the contralateral side on the dermatomes supplied by blocked nerves
Time frame
at 2 hours postoperatively2
Total dose of rescue analgesia
once the VAS score will be ≥ 3, rescue analgesia in the form of 1 μg/kg fentanyl will be given and the total dose consumed will be recorded
Time frame
in the first 24 hour postoperativelySponsors and contacts
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Source ClinicalTrials.gov