Supra Inguinal Fascia Iliaca Block as Rescue Analgesia Following Total Hip Arthroplasty

NCT ID: NCT06982625

Last Updated: 2025-09-25

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

310 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-22

Study Completion Date

2027-12-31

Brief Summary

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Hip replacement surgery is one of the most commonly performed surgical procedures in France, with approximately 150,000 procedures per year. Postoperative recovery has significantly improved in recent years, enabling faster rehabilitation.

Although generally considered moderately painful, hip replacement surgery can, in some difficult-to-predict cases, lead to severe postoperative pain, requiring high doses of morphine, which may cause side effects and delay recovery.

In other surgical procedures, regional anesthesia (nerve blocks) has been successfully used for pain relief. However, its effectiveness after hip replacement surgery has not yet been fully proven.

A recent regional anesthesia technique-the Supra-Inguinal Fascia Iliaca Block (SIFIB)-which numbs a significant portion of the nerves around the hip, has recently been developed.

When performed in all patients undergoing hip arthroplasty, the benefit of this technique could not be demonstrated. In addition, this technique may lead to transcient muscle blockade, wich also can delay recovery.

In order to limit the use of nerve blocks to painful patients, we designed this study where the nerve block is performed only in patients experiencing significant paint after surgery.

In conclusion, this study aims to assess the benefits of performing a rescue SIFIB in the recovery room for patients who experience significant postoperative pain after hip replacement surgery. The evaluation will focus on pain relief and ability to walk.

No new treatment is being tested. The technique uses a commonly administered local anesthetic to numb the nerves.

Detailed Description

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Conditions

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Hip Arthroplasty, Total Post Operative Pain, Acute Nerve Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, assessor and patient blinded, placebo controlled
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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SIFIB group

The ultrasound probe is placed in a cephalo-caudal orientation, over the inguinal ligament, lateral to the femoral nerve. The iliacus muscle, which is covered caudally by the sartorius muscle and cephalically by the internal oblique muscle, is visualized in depth. Between these two muscles, an area is identified where the iliacus muscle is covered only by subcutaneous tissue. The needle is introduced in a cranio-caudal direction, and the injection is initiated in this area, beneath the fascia iliaca. The needle then advances through the space created by the injection, as far as possible in a cephalic direction, beneath the internal oblique muscle. An injection of 40 ml of 0.1% ropivacaine is administered.

Group Type EXPERIMENTAL

Ultrasound guided supra inguinal fascia iliaca block

Intervention Type PROCEDURE

The ultrasound probe is placed in a cephalo-caudal orientation, over the inguinal ligament, lateral to the femoral nerve. The iliacus muscle, which is covered caudally by the sartorius muscle and cephalically by the internal oblique muscle, is visualized in depth. Between these two muscles, an area is identified where the iliacus muscle is covered only by subcutaneous tissue. The needle is introduced in a cranio-caudal direction, and the injection is initiated in this area, beneath the fascia iliaca. The needle then advances through the space created by the injection, as far as possible in a cephalic direction, beneath the internal oblique muscle. An injection of 40 ml of 0.1% ropivacaine is administered.

Surgical and anesthetic protocol

Intervention Type PROCEDURE

All patients receive standard general anesthesia:

* Induction of anesthesia by sufentanil, ketamine, propofol and tracrium if needed,
* Maintenance of anesthesia by sevoflurane and sufentanil if needed,
* Prevention of PONV by dexamethasone and droperidol,
* Post-operative analgesia by paracetamol, ketoprofene, nefopam, as indicated. Total hip arthroplasty is performed by anterior or postero-lateral approach, depending on surgeon preference.

In the post-anesthesia care unit, if numerical pain rating scale at rest is \>=4, patients are randomized to receive experimental or placebo intervention.

Placebo group

Five milliliters of saline are injected subcutaneously under ultrasound guidance

Group Type SHAM_COMPARATOR

Placebo Injection

Intervention Type PROCEDURE

Five milliliters of saline are injected subcutaneously under ultrasound guidance

Surgical and anesthetic protocol

Intervention Type PROCEDURE

All patients receive standard general anesthesia:

* Induction of anesthesia by sufentanil, ketamine, propofol and tracrium if needed,
* Maintenance of anesthesia by sevoflurane and sufentanil if needed,
* Prevention of PONV by dexamethasone and droperidol,
* Post-operative analgesia by paracetamol, ketoprofene, nefopam, as indicated. Total hip arthroplasty is performed by anterior or postero-lateral approach, depending on surgeon preference.

In the post-anesthesia care unit, if numerical pain rating scale at rest is \>=4, patients are randomized to receive experimental or placebo intervention.

Interventions

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Ultrasound guided supra inguinal fascia iliaca block

The ultrasound probe is placed in a cephalo-caudal orientation, over the inguinal ligament, lateral to the femoral nerve. The iliacus muscle, which is covered caudally by the sartorius muscle and cephalically by the internal oblique muscle, is visualized in depth. Between these two muscles, an area is identified where the iliacus muscle is covered only by subcutaneous tissue. The needle is introduced in a cranio-caudal direction, and the injection is initiated in this area, beneath the fascia iliaca. The needle then advances through the space created by the injection, as far as possible in a cephalic direction, beneath the internal oblique muscle. An injection of 40 ml of 0.1% ropivacaine is administered.

Intervention Type PROCEDURE

Placebo Injection

Five milliliters of saline are injected subcutaneously under ultrasound guidance

Intervention Type PROCEDURE

Surgical and anesthetic protocol

All patients receive standard general anesthesia:

* Induction of anesthesia by sufentanil, ketamine, propofol and tracrium if needed,
* Maintenance of anesthesia by sevoflurane and sufentanil if needed,
* Prevention of PONV by dexamethasone and droperidol,
* Post-operative analgesia by paracetamol, ketoprofene, nefopam, as indicated. Total hip arthroplasty is performed by anterior or postero-lateral approach, depending on surgeon preference.

In the post-anesthesia care unit, if numerical pain rating scale at rest is \>=4, patients are randomized to receive experimental or placebo intervention.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* patient scheduled for a primary total hip arthroplasty under general anesthesia,
* written informed consent.


* contra indication to ropivacaine
* vulnerable person

Exclusion Criteria

* per-operative complication making wheight-bearing and walking contra-indicated.
* patient without significant pain post-operatively.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut Mutualiste Montsouris

OTHER

Sponsor Role lead

Responsible Party

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Abderrahmen BARGAOUI

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Abderrahmen BARGAOUI, MD

Role: PRINCIPAL_INVESTIGATOR

Institut Mutualiste Montsouris

Locations

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Institut Mutualiste Montsouris

Paris, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Chahrazad Bey Boumezrag

Role: CONTACT

+33 156616983

References

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Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H, Van de Velde M. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med. 2017 May/Jun;42(3):327-333. doi: 10.1097/AAP.0000000000000543.

Reference Type BACKGROUND
PMID: 28059869 (View on PubMed)

Zhang XY, Ma JB. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 2019 Jan 25;14(1):33. doi: 10.1186/s13018-018-1053-1.

Reference Type BACKGROUND
PMID: 30683117 (View on PubMed)

Changjun C, Xin Z, Yue L, Liyile C, Pengde K. Key Elements of Enhanced Recovery after Total Joint Arthroplasty: A Reanalysis of the Enhanced Recovery after Surgery Guidelines. Orthop Surg. 2023 Mar;15(3):671-678. doi: 10.1111/os.13623. Epub 2023 Jan 3.

Reference Type BACKGROUND
PMID: 36597677 (View on PubMed)

Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Sache F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med. 2023 Aug;42(4):101264. doi: 10.1016/j.accpm.2023.101264. Epub 2023 Jun 7.

Reference Type BACKGROUND
PMID: 37295649 (View on PubMed)

Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, Raeder J; PROSPECT Working Group* and the European Society of Regional Anaesthesia and Pain Therapy. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021 Aug;76(8):1082-1097. doi: 10.1111/anae.15498. Epub 2021 May 20.

Reference Type BACKGROUND
PMID: 34015859 (View on PubMed)

Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, Mariano ER, Johnson RL, Go G, Hargett MJ, Lee BH, Wendel P, Brouillette M, Kim SJ, Baaklini L, Wetmore DS, Hong G, Goto R, Jivanelli B, Athanassoglou V, Argyra E, Barrington MJ, Borgeat A, De Andres J, El-Boghdadly K, Elkassabany NM, Gautier P, Gerner P, Gonzalez Della Valle A, Goytizolo E, Guo Z, Hogg R, Kehlet H, Kessler P, Kopp S, Lavand'homme P, Macfarlane A, MacLean C, Mantilla C, McIsaac D, McLawhorn A, Neal JM, Parks M, Parvizi J, Peng P, Pichler L, Poeran J, Poultsides L, Schwenk ES, Sites BD, Stundner O, Sun EC, Viscusi E, Votta-Velis EG, Wu CL, YaDeau J, Sharrock NE. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med. 2021 Nov;46(11):971-985. doi: 10.1136/rapm-2021-102750. Epub 2021 Aug 25.

Reference Type BACKGROUND
PMID: 34433647 (View on PubMed)

Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013 Apr;118(4):934-44. doi: 10.1097/ALN.0b013e31828866b3.

Reference Type BACKGROUND
PMID: 23392233 (View on PubMed)

Other Identifiers

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2024-A02290-47

Identifier Type: OTHER

Identifier Source: secondary_id

ANESTH-03-2024

Identifier Type: -

Identifier Source: org_study_id

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