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Hip ArthropathyNCT03801863

The Use of Lumbar Erector Spinae Plane Block for Hip Arthroplasty at the L4 Interspace

An observational study of Hip Arthropathy and Regional Anesthesia, run by Montefiore Medical Center at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Over 300,000 hip arthroplasties are performed each year in the United States.1 This number has been steadily increasing over the last two decades, likely due to increased life expectancy and, more significantly, the obesity epidemic. Traditionally, this procedure has been performed under general anesthesia. Read more about this study

Who is it for?
Ages 18 to 99 yearsHealthy volunteers can take part
Conditions the study is for
Hip Arthropathy, Regional Anesthesia
What is being tested?
Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375% and Ropivacaine
Type of treatment
Surgery or procedure
How many people
65 participants
Where
1 siteUnited States
Study dates
1 Mar 2019to 26 Jan 2022
Phase
Observational
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 99 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients undergoing primary total hip replacement under neuraxial anesthesia

Who may be able to join

  • Patients undergoing primary hip arthroplasty
  • American Society of Anesthesiologists (ASA) Category 1, 2, and 3
  • Patients age ≥18 years

Who cannot join

  • Patient refusal
  • Inability to understand and sign consent
  • Infection at the injection site
  • Known allergy or hypersensitivity to ropivacaine or other amide local anesthetics
  • Contraindication or patient refusal to get spinal anesthesia
  • Thrombocytopenia (platelets < 100,000)
Show all 9Show fewer
  • Coagulopathy (INR > 1.4)
  • Use of anticoagulant drugs that have not been discontinued in an appropriate amount of time before the surgery
  • ASA Category 4 and 5

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Montefiore Medical Center- Wakefield Campus

    The Bronx, New York, 10467

Other trials in United States

About this study

Official title: The Use of Lumbar Erector Spinae Plane Block for Hip Arthroplasty at the L4 Interspace- a Randomized Controlled Study Comparing the 24-hour Opioid Requirements.

Over 300,000 hip arthroplasties are performed each year in the United States.1 This number has been steadily increasing over the last two decades, likely due to increased life expectancy and, more significantly, the obesity epidemic. Traditionally, this procedure has been performed under general anesthesia. However, neuraxial and regional anesthesia have become more commonly utilized to aid in postoperative analgesia. Postoperative pain control has a significant impact on earlier ambulation, initiation of physical therapy, better functional recovery, and overall patient satisfaction.2 Moreover; optimal pain management can reduce the duration of hospitalization and the risk of adverse events, such as deep vein thrombus. The use of regional anesthesia reduces the postoperative opioid requirement, thereby decreasing the degree to which patients suffer the side effects of opioids, namely sedation and constipation, and less frequently nausea, vomiting, respiratory depression, pruritus, and retention. In the past, femoral nerve block, fascia iliaca compartment block, lumbar plexus block and the quadratus lumborum block have been shown efficacious for pain relief for hip arthroplasty. However there are several risk factors such as quadricep weakness and difficulty of the block that causes a limitation in the used of this blocks. Recently, the erector spinae plane block has been introduced as an alternative to the blocks above. This block was first described in the literature in 2016 when it was used to treat chronic neuropathic thoracic pain. Since then, there have been studies demonstrating its efficacy with a thoracic approach for analgesia in breast surgery and rib fractures.9 Only two case reports to date have demonstrated a lumbar approach to achieve analgesia for hip arthroplasty.10,11 The purpose of the study is to determine whether or not a lumbar erector spinae plane block is effective at improving postoperative pain in patients receiving hip arthroplasty.

Read the detailed description

Hypothesis:

The erector spinae plane block will decrease opioid requirements in patients undergoing hip arthroplasty as compared to patients that do not receive the block.

Primary Objective:

To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal vs. spinal alone.

Secondary Endpoints:

To evaluate the pain scores at discharge from PACU, at 2 hours post PACU discharge, at 24 hours and at 48 hours postoperative; to evaluate the sensory distribution of the block (T10-L5); to evaluate whether or not patients that receive the block have evidence of quadricep muscle weakness

Design and methods This is a randomized, prospective study in patients receiving hip arthroplasty. Patients will be assigned to receive a lumbar erector spinae block versus no block. There will be no change in the primary anesthetic technique (spinal anesthesia with sedation) since these patients routinely get spinal anesthesia for hip arthroplasty. Consent for the study will be obtained in the preoperative area upon arrival for surgery. Patients will then be randomized into one of the two groups above. One group will receive a lumbar erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine before the procedure using ultrasound guidance. The second group will receive no peripheral nerve block to serve as the control. Patients to receive a nerve block will receive mild sedation (1-2mg midazolam ± ≤100mcg fentanyl). All patients receiving nerve blocks will have a printed image of the block thus to confirm proper spread of local anesthetic both cranially and caudally.

Postoperatively, the PACU nurse will be asked to document pain scores according to the Visual Analog Scale (VAS) and total dose of opioids given. The distribution of the sensory block and motor weakness will be documented in the anesthesiologist's PACU discharge note. For patients that receive the block, the Physical therapist note will be assessed for any report of quadriceps muscle weakness (i.e., evidence of buckling while walking).

For postoperative data collection, opioid consumption totals and the pain scores at 2 hours post admission, at 24 hours and 48 hours post-procedure will be collected from the electronic medical record (EMR) as documented by nurses on the admitting floor. Additionally, the Acute Pain service, who rounds on all patients that receive nerve blocks, will make a note of the pain scores of the patient and any residual muscle weakness or decreased sensation at 24- and 48-hours post-procedure. All data will then be extracted from the EMR by the research assistant.

Being tested
Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375%, Ropivacaine
Keywords
Erector Spinae Plane Block, Ropivacaine, Ultrasound guided nerve block

What participants receive

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

  • Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375%Procedure or surgery

    Ultrasound-guided Erector Spinae Plane Block will be done at L4 interspace. Ropivacaine 0.375% will be used.

  • RopivacaineDrug

    Using 0.375% Ropivacaine in the nerve block

Study groups in NCT03801863
Study groupRoleWhat they receive
Ultrasound-guided Erector Spinae BlockPatients will then be randomized into one of the two groups above. One group will receive a lumbar erector spinae block at L4 with 30ml of 0.375% ropivacaine with 50 mcg of dexmedetomidine before the procedure using ultrasound guidance. The second group will receive no peripheral nerve block to serve as the control. All patients receiving nerve blocks will have a printed image of the block thus to confirm proper spread of local anesthetic both cranially and caudally.
Receives: Procedure: Ultrasound-guided Erector Spinae Plane Block with Ropivacaine 0.375%; Drug: Ropivacaine
No Ultrasound-guided Erector Spinae BlockPatients with no peripheral nerve block to serve as the control.

What is being measured

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

  1. Opioid Consumption in PACU and 24 hours post surgery

    To compare the opioid consumption in the post-anesthesia care unit (PACU) and at 24 hours postoperative (in morphine equivalents) in patients receiving regional anesthesia with spinal vs. spinal alone.

    Measured: 24 hours

Secondary outcomes (5)
  1. Pain scores at 2 hours post PACU discharge

    To evaluate the pain scores at 2 hours post PACU discharge

    Measured: 2 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain

  2. To evaluate the sensory distribution of the block (T10-L5).

    Will test for temperature difference using ice cube.

    Measured: 2 hours post-surgery

  3. To evaluate whether or not patients that receive the block have evidence of quadricep muscle weakness

    Will have patient walk and Physical Therapist will assess for buckling of knee or potential falls while ambulating.

    Measured: 30 hours post-surgery

  4. Pain scores at 24 hours post PACU discharge

    To evaluate the pain scores at 24 hours post PACU discharge

    Measured: 24 hours. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain

  5. Pain scores at 48 hours postoperative

    To evaluate the pain scores at 48 hours postoperative.

    Measured: 48 hours post-surgery. Pain scores from 1 to 10. 10 being the worse pain and 1 being the least pain

Timeline

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

  1. First posted14 Jan 2019
  2. Study start1 Mar 2019
  3. Primary completion26 Jan 2022
  4. Study completion26 Jan 2022

Why it stopped: Study "Administratively closed" by Albert Einstein College of Medicine IRB as approval expired. PI no longer with institution. IRB approval expiry date used as Primary Completion date and Study Completion Date. Enrollment total derived from CTMS

Resources

More details

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

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
65 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03801863
Sponsor's protocol ID
2018-9687
Status last verified
Jul 2023
First submitted
5 Jan 2019
Last updated
21 Jul 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief. 2015 Feb;(186):1-8.

    PubMed 25714040
  • Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018 Sep;36(3):403-415. doi: 10.1016/j.anclin.2018.04.001. Epub 2018 Jul 11.

    PubMed 30092937
  • Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018 Nov;50:65-68. doi: 10.1016/j.jclinane.2018.06.033. Epub 2018 Jul 2.

    PubMed 29980005
  • Tulgar S, Senturk O. Ultrasound guided Erector Spinae Plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty. J Clin Anesth. 2018 Feb;44:68. doi: 10.1016/j.jclinane.2017.11.006. Epub 2017 Nov 14. No abstract available.

    PubMed 29149734
  • Tulgar S, Selvi O, Senturk O, Ermis MN, Cubuk R, Ozer Z. Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries. J Clin Anesth. 2018 Jun;47:5-6. doi: 10.1016/j.jclinane.2018.02.014. Epub 2018 Mar 6. No abstract available.

    PubMed 29522966
  • Duellman TJ, Gaffigan C, Milbrandt JC, Allan DG. Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty. Orthopedics. 2009 Mar;32(3):167.

    PubMed 19309064

Questions about this trial

What is this clinical trial studying?

An observational study of Hip Arthropathy and Regional Anesthesia, run by Montefiore Medical Center at 1 site in United States.

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: stopped early, as of the sponsor's last update on 21 Jul 2023. 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 United States. 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 was stopped early (reason given: Study "Administratively closed" by Albert Einstein College of Medicine IRB as approval expired. PI no longer with institution. IRB approval expiry date used as Primary Completion date and Study Completion Date. Enrollment total derived from CTMS). Results are not available in the source record.

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?

Opioid Consumption in PACU and 24 hours post surgery (time frame: 24 hours). 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 NCT03801863, which also lists 6 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 21 Jul 2023.

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