Ultrasound-guided supine lumbar plexus block versus iliac fascia block for analgesia in older adult patients undergoing hip replacement: a randomized controlled trial

Abstract

Background and objectives: Anesthesia is an important part of hip replacement in older adult patients. Lumbar plexus block and iliac fascia block are common block methods in hip replacement. This study will compare the analgesic effects of ultrasound-guided supine lumbar plexus block and multi-angle multi-point iliac fascia block during hip replacement in older adult patients. The result will identify the optimal analgesic regimen. Methods: This prospective, single-center (Lu’an Civily Hospital in China), randomized controlled trial will include 208 older adult patients who are scheduled to undergo hip replacement. The patients will be randomly assigned to one of two groups (n = 104/group). In the lumbar plexus-block group, patients will undergo supine lumbar plexus block, general anesthesia using a laryngeal mask airway, and subsequent hip replacement. In the iliac fascia-block group, patients will undergo multi-angle multi-point iliac fascia block, general anesthesia using a laryngeal mask airway, and subsequent hip replacement. After surgery, all patients will be followed up for 24 hours. Results: The primary outcome measure of this study is a Visual Analog Scale score obtained 24 hours post-surgery, which will be used to evaluate the postoperative analgesic effect. The secondary outcome measures are Visual Analog Scale scores at 2, 6 and 12 hours post-surgery, heart rate at various time points during the surgery (laryngeal mask placement, T0; surgical incision, T1; surgical reaming, T2; prosthesis implantation, T3; incision suture, T4; and resuscitation, T5), mean arterial pressure, blood oxygen saturation, intraoperative sufentanil, perdipine, and ephedrine dosages, total amount of intravenous patient-controlled analgesics at 2, 6, 12, and 24 hours post-surgery, and incidence of adverse reactions. Results of a pilot study involving 60 older adult patients who underwent hip replacement during March 2018 through September 2018 showed that intraoperative sufentanil, perdipine, and ephedrine dosages were significantly lower in the lumbar plexus-block group (n = 30) than in the iliac fascia-block group (n = 30; P Conclusion: Results from this study will provide evidence indicating whether ultrasound-guided supine lumbar plexus block in combination with general anesthesia can more effectively maintain stable hemodynamic indices during hip replacement and whether it results in more encouraging postoperative analgesic effects in older adult patients than multi-angle multi-point iliac fascia block. Ethics and trial registration: This study was approved by the Medical Ethics Committee of Lu’an Civily Hospital in March 2018 (approval No. PJ2018-001). The study protocol version is 1.0. Patients participating in this study will provide their written informed consent after fully understanding the study protocol. This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019888).