BACKGROUND: 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.
OBJECTIVE: To investigate the analgesic effect of ultrasound-guided lumbar plexus block in supine position versus multi-angle multi-point iliac fascia block during hip replacement in older adult patients to screen the optimal analgesic regimen.
METHODS: This prospective, single-center, randomized, controlled trial will include 208 older adult patients scheduled to undergo hip replacement from wards of Lu’an Civily Hospital in China. These patients will be randomly assigned to two groups (n = 104/group). In the lumbar plexus block group, patients will undergo lumbar plexus block in supine position, general anesthesia using a laryngeal mask airway and later 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 later hip replacement. After surgery, all patients will be followed up for 24 hours. This study was approved by Medical Ethics Committee of Lu’an Civily Hospital in China in March 2018 (approval No. PJ2018-001). The study protocol is 1.0. Patients participating in this study will sign informed consent after fully understanding the study protocol.
RESULTS AND CONCLUSION: The primary outcome measure of this study is Visual Analog Scale score at 24 hours post-surgery, which is used to evaluate postoperative analgesic effect. The secondary outcome measures of this study are Visual Analog Scale score 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 from March to 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 < 0.05); heart rate at T2, T3, T4 and T5 was significantly lower in the lumbar plexus block group than in the iliac fascia block group (
P < 0.05); heart rate at T1, T2, T3, T5 was significantly greater than that at T0 in the iliac fascia block group (
P < 0.05); mean arterial pressure at T1, T2, T3, T4 and T5 was significantly lower in the lumbar plexus block group than that in the iliac fascia block group (
P < 0.05), and mean arterial pressure at T1, T2, T3 and T4 was significantly higher than that at T0 in the iliac fascia block group (
P < 0.05). Mean arterial pressure at T3 and T4 was significantly lower than that at T0 in the lumbar plexus block group (
P < 0.05). Visual Analogue Scale score at 6, 12 and 24 hours post-surgery was significantly higher in the iliac fascia block group than in the lumbar plexus block group (
P < 0.05). Results from this study will provide evidence indicating whether ultrasound-guided lumbar plexus block in supine position in combination with general anesthesia can more effectively maintain stable hemodynamic index during hip replacement and exhibits more encouraging postoperative analgesic effects in older adult patients than multi-angle multi-point iliac fascia block. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800019888) on December 7, 2018.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程