Lumbar ESPB in Hip Replacement Surgery

NCT ID: NCT06282666

Last Updated: 2024-07-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-19

Study Completion Date

2025-08-01

Brief Summary

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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.

Detailed Description

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This is a prospective trial in patients undergoing elective hip replacement surgery.

Written informed consent will be obtained from each patient, and our study will be conducted following the tenets of the Declaration of Helsinki for medical research involving human subjects.

Before the surgery, preoperative pain severity, chronic pain severity, and ability to sit, stand, and walk will be assessed.

Each participant will be anesthetized with spinal technique and randomly allocated patients according to postoperative analgesia to the continuous epidural (Epidural) group and the continuous lumbar erector spinae plane block (ESPB) group. Both regional techniques will be continued during the first day. Investigators will measure postoperative oxycodone consumption with a patient-controlled analgesia (PCA) pump. At several points, the patients' pain at rest and during activity will be evaluated on the visual analog scale (VAS, 0-10), their quadriceps femoris muscle strength on the Lovett scale (0-5), and their ability to sit, stand upright, and walk on the Timed Up and Go test. Moreover, the patient's recovery will be assessed through the Quality of Recovery 40 (QoR-40) questionnaire on the first postoperative day.

After the patient's discharge, information regarding acute and chronic pain severity and quality of recovery will be collected during the phone interview.

Conditions

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

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Two groups will be randomly allocated to Epidural and ESPB (1:1)
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Participants will not be aware of the type of continuous blockade. Care providers, including doctors and nurses, will not be aware of patient allocation.

Physiotherapists assessing outcomes will not be aware of patient allocation.

Study Groups

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Epidural

Combined spinal and epidural anesthesia will be performed before the surgery in the patient's lateral position with the operated hip down. The Espocan set will be used (B.Braun). After identification of the epidural space on the level of L3/L4, 0.5% bupivacaine (Marcaine Heavy Spinal) with fentanyl (5 mcg/mL) will be injected through the 27 G pencil point spinal needle. Then, the epidural catheter will be placed and a test dose of 2% lidocaine (2 mL) will be administered. At the end of the surgery, the patient will receive 5 mL of a mixture containing 0.1% bupivacaine with fentanyl (2 mcg/mL). Moreover, we will administer 5 mg of oxycodone i.v.

the mixture of bupivacaine and fentanyl will be administered in a constant flow of 5 mL/h for a day.

Group Type EXPERIMENTAL

Spinal anesthesia

Intervention Type PROCEDURE

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.

Epidural analgesia

Intervention Type PROCEDURE

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).

patient-controlled analgesia

Intervention Type PROCEDURE

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.

Timed Up and Go test

Intervention Type DIAGNOSTIC_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.

neuropathic pain symptom inventory

Intervention Type DIAGNOSTIC_TEST

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.

Lovett test

Intervention Type DIAGNOSTIC_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.

Visual analog scale

Intervention Type DIAGNOSTIC_TEST

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.

Quality of Recovery 40

Intervention Type DIAGNOSTIC_TEST

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.

Ability to sit, stand upright, and walk

Intervention Type DIAGNOSTIC_TEST

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

ESPB

Spinal anesthesia will be performed in the patient's lateral position with the operated hip down. 0.5% bupivacaine (Marcaine Heavy Spinal) with fentanyl (5 mcg/mL) will be used and a 25-27 G pencil point spinal needle.

The lumbar ESPB will be performed under ultrasound control at the L3 level on the ipsilateral site of the surgery. After dissection with 0.9 NaCl, a catheter will be left in the ESP. Then, we will administer 0.25% bupivacaine with epinephrine (5mcg/mL), 0.4 mL per kg, up to 40 mL. Moreover, 5 mg of oxycodone i.v. will be administered A mixture of 0.1% bupivacaine with fentanyl (2 mcg/mL) will be given in a constant flow of 5 mL/h for a day.

Group Type EXPERIMENTAL

Spinal anesthesia

Intervention Type PROCEDURE

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.

lumbar erector spinae plane block

Intervention Type PROCEDURE

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.

patient-controlled analgesia

Intervention Type PROCEDURE

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.

Timed Up and Go test

Intervention Type DIAGNOSTIC_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.

neuropathic pain symptom inventory

Intervention Type DIAGNOSTIC_TEST

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.

Lovett test

Intervention Type DIAGNOSTIC_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.

Visual analog scale

Intervention Type DIAGNOSTIC_TEST

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.

Quality of Recovery 40

Intervention Type DIAGNOSTIC_TEST

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.

Ability to sit, stand upright, and walk

Intervention Type DIAGNOSTIC_TEST

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

Interventions

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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.

Intervention Type 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.

Intervention Type 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).

Intervention Type 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.

Intervention Type PROCEDURE

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.

Intervention Type 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.

Intervention Type 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.

Intervention Type 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.

Intervention Type 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.

Intervention Type 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.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Subarachnoid anesthesia ESPB PCA TUG NPSI VAS QoR-40

Eligibility Criteria

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Inclusion Criteria

* primary hip replacement surgery due to coxarthrosis
* anesthetized with spinal technique
* able to use PCA pump
* having access to phone

Exclusion Criteria

* patients taking painkillers not related to coxarthrosis;
* having active cancer,
* dementia or challenging contact with the patient;
* suffering from depression or other psychiatric disorders that required antidepressant treatment;
* consuming alcohol or recreational drug addiction;
* contraindications to the regional block.
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Lublin

OTHER

Sponsor Role lead

Responsible Party

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Michał Borys

MD, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paweł Piwowarczyk, M.D., Ph.D.

Role: STUDY_CHAIR

Medical University of Lublin

Locations

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II Department of Anesthesia and Intensive Care

Lublin, , Poland

Site Status RECRUITING

Countries

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Poland

Central Contacts

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Michał Borys, M.D., Ph.D.

Role: CONTACT

506350569 ext. +48

Paweł Kutnik, M.D.

Role: CONTACT

608769410 ext. +48

Facility Contacts

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Michał A Borys, M.D. Ph.D

Role: primary

506350569 ext. +48

Paweł Kutnik, M.D.

Role: backup

608769410 ext. +48

References

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Hanych A, Kutnik P, Pasiak P, Zakrzewska-Szalak A, Wichowska O, Jednakiewicz M, Nogalski A, Piwowarczyk P, Borys M. Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery - a prospective pilot study. Anaesthesiol Intensive Ther. 2023;55(4):272-276. doi: 10.5114/ait.2023.132517.

Reference Type BACKGROUND
PMID: 38084571 (View on PubMed)

Other Identifiers

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KE-0254/150/2019

Identifier Type: -

Identifier Source: org_study_id

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