Intrathecal Opioid Versus Ultrasound Guided Fascia Iliaca Plane Block for Analgesia After Primary Hip Arthroplasty
Description:
There were 6312 primary hip replacements performed in Scotland during the one year period
2007 – 2008. Patients undergoing hip arthroplasty commonly have significant comorbidity and
associated polypharmacy providing many potential challenges for the anaesthetic doctor. The
optimal way to anaesthetise these patients remains to be fully established although many
potential methods exist. The main choice is between general anaesthesia (GA) and regional
anaesthesia (RA) or a combination of the two. In a recent systematic review, RA was found to
reduce post-operative pain, morphine consumption and nausea and vomiting compared with
systemic analgesia.
Spinal anaesthesia is a popular form of RA used in many patients undergoing hip arthroplasty.
Opioid drugs are frequently added to the spinal injection in order to prolong post-operative
pain relief. However, this is associated with side effects including respiratory depression,
urinary retention, nausea and vomiting, and pruritus. Such adverse effects may be
uncomfortable for the patient and can delay mobilisation, recovery and eventual discharge.
In patients undergoing hip arthroplasty, peripheral nerve blockade has been shown to improve
pain scores and reduce morphine consumption. A peripheral nerve block called the fascia
iliaca plane block has shown significant promise as a method of providing sensory blockade of
the main nerves which supply pain to the hip. The use of ultrasound for the performance of
fascia iliaca plane block has been shown to increase reliability compared with the landmark
technique though the clinical benefits of this have not yet been fully investigated.
Compared to nerve stimulation or landmark techniques of nerve localisation, ultrasound has
been shown to increase success rates, reduce block onset time, increase block duration,
reduce volumes of local anaesthetic required and increase patient satisfaction.
The investigators hypothesise that by increasing the success rate of the fascia iliaca block
with ultrasound, it will be possible to achieve superior analgesia post-operatively. Our aim
is to assess whether the ultrasound guided fascia iliaca plane block can be used as an
alternative to intrathecal morphine in the provision of post-operative analgesia for primary
hip arthroplasty. If this is the case, intrathecal opioid could be removed from the spinal
anaesthetic. This could in theory have significant safety benefits whilst also reducing side
effects. Ultrasound guided fascia iliaca block has not yet been evaluated clinically as a
method of providing post-operative analgesia following primary hip arthroplasty. The
investigators believe that further investigation of this technique will provide a valuable
contribution to existing knowledge and will change current practice.
Condition:
Analgesia
Treatment:
ultrasound guided fascia iliaca block
Start Date:
May 2011
Sponsor:
Rachel Kearns
For More Information:
https://clinicaltrials.gov/show/NCT01217294