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Hip OsteoarthritisNCT03744065

Lumbar Plexus and Suprainguinal Fascia Iliaca Blocks For Total Hip Replacement

A study testing lumbar plexus block and suprainguinal fascia iliaca block in people with Hip Osteoarthritis and Pain, Acute, run by University of Chile at 1 site in Chile.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The nerves from lumbar plexus (LP) are the current target to achieve analgesia after a total hip arthroplasty (THA). Lumbar plexus block (LPB) is an alternative that provides optimal postoperative analgesia. However, many adverse effects and complications have been reported due to its proximity to vital structures. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
lumbar plexus block and suprainguinal fascia iliaca block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteChile
Study dates
19 Nov 2018to 23 Jan 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age between 18 and 80 years
  • American Society of Anesthesiologists classification 1-3
  • Body mass index between 20 and 35 (kg/m2)

Who cannot join

  • Adults who are unable to give their own consent
  • Pre-existing neuropathy (assessed by history and physical examination)
  • Coagulopathy (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. platelets ≤ 100, International Normalized Ratio ≥ 1.4 or prothrombin time ≥ 50)
  • Renal failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. creatinine ≥ 100)
  • Hepatic failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. transaminases ≥ 100)
  • Allergy to local anesthetics (LAs) or morphine
Show all 9Show fewer
  • Pregnancy
  • Prior surgery in the corresponding side of the lumbar o suprainguinal area
  • Chronic pain syndromes requiring opioid intake at home

Trial locations and contacts

1 site in 1 country.

Chile1 site
  • Hospital Clínico Universidad de Chile

    Santiago, Santiago Metropolitan, 8380456

Other trials in Chile

About this study

Official title: A Randomized Comparison Between Ultrasound Guided Lumbar Plexus and Suprainguinal Fascia Iliaca Blocks For Total Hip Replacement Analgesia

The nerves from lumbar plexus (LP) are the current target to achieve analgesia after a total hip arthroplasty (THA). Lumbar plexus block (LPB) is an alternative that provides optimal postoperative analgesia. However, many adverse effects and complications have been reported due to its proximity to vital structures. Because of these shortcomings, an alternative to block the LP nerves is required.

In a recent trial suprainguinal Fascia Iliaca Block (SFIB) was reported to provide reliable analgesia in THA. SFIB may carry a lower risk profile, however, no study has compared the efficacy of LPB and SFIB in this setting.

Thus, this randomized trial is set out to compare US guided LPB and SFIB for analgesia after THA. The hypothesis is that both blocks would result in similar postoperative opioid (morphine) consumption at 24 hours and, therefore, designed the study as an equivalence trial.

Being tested
lumbar plexus block, suprainguinal fascia iliaca block
Keywords
nerve block, fascia iliaca, hip replacement, lumbar plexus
Medical subject headings
Osteoarthritis, Hip, Acute Pain, Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • lumbar plexus blockProcedure or surgery

    Injection with ultrasound guidance of 40 mL of levobupivacaine 0.25% with 5 micrograms of epinephrine per mL and dexamethasone 4 milligrams, in the posteromedial quadrant of psoas muscle

  • suprainguinal fascia iliaca blockProcedure or surgery

    Injection with ultrasound guidance of 40 mL of levobupivacaine 0.25% with 5 micrograms of epinephrine per mL and dexamethasone 4 milligrams, underneath the fascia iliaca at the suprainguinal level

Study groups in NCT03744065
Study groupRoleWhat they receive
Lumbar plexus blockActive comparatorPatients randomized to receive an ultrasound-guided lumbar plexus block
Receives: Procedure: lumbar plexus block
Suprainguinal fascia iliaca blockExperimentalPatients randomized to receive an ultrasound-guided suprainguinal fascia iliaca block
Receives: Procedure: suprainguinal fascia iliaca block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Morphine consumption over 24 hours

    Total morphine consumption over 24 hours post block

    Measured: 24 hours post block

Secondary outcomes (22)
  1. Performance time

    Interval between the start of skin disinfection and the end of local anesthetic injection

    Measured: 2 hours after surgery

  2. Number of needle passes

    The initial needle insertion counted as the first pass. Any subsequent needle advancement that is preceded by a retraction of at least 10 mm counts as an additional pass

    Measured: 2 hours after surgery

  3. Postoperative static pain at 3 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 3 hours after the block

  4. Postoperative static pain at 6 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 6 hours after the block

  5. Postoperative static pain at 12 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 12 hours after the block

  6. Postoperative static pain at 24 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 24 hours after the block

  7. Postoperative dynamic pain at 3 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 3 hours after the block

  8. Postoperative dynamic pain at 6 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 6 hours after the block

  9. Postoperative dynamic pain at 12 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 12 hours after the block

  10. Postoperative dynamic pain at 24 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 24 hours after the block

  11. Postoperative static pain at 48 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 48 hours after the block

  12. Postoperative dynamic pain at 48 hours after block

    Pain evaluated in Numeric Rating Score from 0 to 10 points

    Measured: 48 hours after the block

  13. Time until first morphine demand

    Time until first patient-controlled analgesia morphine demand

    Measured: 48 hours after the block

  14. Block assessment at 3 hours

    Sensorimotor block assessed using a 10-point composite score evaluating sensory block of the lateral femoral cutaneous, femoral and obturator nerves, and motor block of femoral and obturator nerves.

    Sensation will be assessed with ice on then lateral, anterior and medial thigh 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.

    Motor function will be assessed for each nerve with a 0 to 2 points scale where 0= no motor block; 1= paresis; 2= paralysis.

    Measured: 3 hours after the block

  15. Block assessment at 6 hours

    Sensorimotor block assessed using a 10-point composite score evaluating sensory block of the lateral femoral cutaneous, femoral and obturator nerves, and motor block of femoral and obturator nerves.

    Sensation will be assessed with ice on then lateral, anterior and medial thigh 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.

    Motor function will be assessed for each nerve with a 0 to 2 points scale where 0= no motor block; 1= paresis; 2= paralysis.

    Measured: 6 hours after the block

  16. Block assessment at 24 hours

    Sensorimotor block assessed using a 10-point composite score evaluating sensory block of the lateral femoral cutaneous, femoral and obturator nerves, and motor block of femoral and obturator nerves.

    Sensation will be assessed with ice on then lateral, anterior and medial thigh 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.

    Motor function will be assessed for each nerve with a 0 to 2 points scale where 0= no motor block; 1= paresis; 2= paralysis.

    Measured: 24 hours after the block

  17. Incidence of block related adverse events

    Incidence of adverse events related to nerve block (vascular puncture, local anesthetic systemic toxicity, epidural spread)

    Measured: 3 hours after block

  18. Incidence of opioid related adverse events

    Incidence of adverse events related to opioid use (nausea/vomiting, pruritus, somnolence, respiratory depression)

    Measured: 48 hours after block

  19. Incidence of Inability to perform physiotherapy

    Inability to perform physiotherapy due to pain (score more than 4 in Numeric Rating Score from 0 to 10 points) or motor blockade.

    Measured: 24 hours after the block

  20. Surgical duration

    Time between skin incision and closure

    Measured: 4 hours

  21. Readiness to discharge

    Days to be ready for discharge following physiotherapist criteria

    Measured: 4 days after surgery

  22. Length of hospital stay

    Length of hospital stay after surgery

    Measured: 7 days after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Nov 2018
  2. Study start19 Nov 2018
  3. Primary completion22 Jan 2020
  4. Study completion23 Jan 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03744065
Sponsor's protocol ID
OAIC1001/18
Status last verified
Jun 2020
First submitted
13 Nov 2018
Last updated
4 Jun 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Siddiqui ZI, Cepeda MS, Denman W, Schumann R, Carr DB. Continuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2007 Sep-Oct;32(5):393-8. doi: 10.1016/j.rapm.2007.04.008.

    PubMed 17961837
  • Klein SM, D'Ercole F, Greengrass RA, Warner DS. Enoxaparin associated with psoas hematoma and lumbar plexopathy after lumbar plexus block. Anesthesiology. 1997 Dec;87(6):1576-9. doi: 10.1097/00000542-199712000-00040. No abstract available.

    PubMed 9416746
  • Aida S, Takahashi H, Shimoji K. Renal subcapsular hematoma after lumbar plexus block. Anesthesiology. 1996 Feb;84(2):452-5. doi: 10.1097/00000542-199602000-00027. No abstract available.

    PubMed 8602680
  • Aveline C, Bonnet F. Delayed retroperitoneal haematoma after failed lumbar plexus block. Br J Anaesth. 2004 Oct;93(4):589-91. doi: 10.1093/bja/aeh242. Epub 2004 Aug 20.

    PubMed 15321930
  • Weller RS, Gerancher JC, Crews JC, Wade KL. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated. Anesthesiology. 2003 Feb;98(2):581-5. doi: 10.1097/00000542-200302000-00044. No abstract available.

    PubMed 12552223
  • Gentili M, Aveline C, Bonnet F. [Total spinal anesthesia after posterior lumbar plexus block]. Ann Fr Anesth Reanim. 1998;17(7):740-2. doi: 10.1016/s0750-7658(98)80112-3. French.

    PubMed 9750813
  • Pousman RM, Mansoor Z, Sciard D. Total spinal anesthetic after continuous posterior lumbar plexus block. Anesthesiology. 2003 May;98(5):1281-2. doi: 10.1097/00000542-200305000-00034. No abstract available.

    PubMed 12717153
  • Duarte LT, Saraiva RA. [Total spinal block after posterior lumbar plexus blockade: case report.]. Rev Bras Anestesiol. 2006 Oct;56(5):518-23. doi: 10.1590/s0034-70942006000500010. Portuguese.

    PubMed 19468598
  • Dogan Z, Bakan M, Idin K, Esen A, Uslu FB, Ozturk E. Total spinal block after lumbar plexus block: a case report. Braz J Anesthesiol. 2014 Mar-Apr;64(2):121-3. doi: 10.1016/j.bjane.2013.03.002. Epub 2013 Oct 11.

    PubMed 24794455
  • Gadsden JC, Lindenmuth DM, Hadzic A, Xu D, Somasundarum L, Flisinski KA. Lumbar plexus block using high-pressure injection leads to contralateral and epidural spread. Anesthesiology. 2008 Oct;109(4):683-8. doi: 10.1097/ALN.0b013e31818631a7.

    PubMed 18813048
  • Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov;97(5):1274-80. doi: 10.1097/00000542-200211000-00034.

    PubMed 12411815
  • Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989 Dec;69(6):705-13.

    PubMed 2589650
  • Dolan J, Williams A, Murney E, Smith M, Kenny GN. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med. 2008 Nov-Dec;33(6):526-31. doi: 10.1016/j.rapm.2008.03.008.

    PubMed 19258967
  • Kumar K, Pandey RK, Bhalla AP, Kashyap L, Garg R, Darlong V, Malhotra R, Yadav CS. Comparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study. Acta Anaesthesiol Belg. 2015;66(3):95-100.

    PubMed 26767235
  • Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011 Apr;66(4):300-5. doi: 10.1111/j.1365-2044.2011.06628.x. Epub 2011 Feb 24.

    PubMed 21401544

Questions about this trial

What is this clinical trial studying?

A study testing lumbar plexus block and suprainguinal fascia iliaca block in people with Hip Osteoarthritis and Pain, Acute, run by University of Chile at 1 site in Chile.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jun 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Chile. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Morphine consumption over 24 hours (time frame: 24 hours post block). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03744065, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jun 2020.

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