Lumbar Plexus vs Quadratus Lumborum Block in Post-operative Pain Following Total Hip Replacement
Status:
Completed
Trial end date:
2020-05-30
Target enrollment:
Participant gender:
Summary
The Lumbar Plexus (LP) block is currently used as the standard-of-care regional anesthesia
technique to provide postoperative pain management after primary hip replacement surgery at
UPMC Shadyside Hospital. However, the LP technique is complex and can be associated with
potentially serious side effects, including nerve injury, major bleeding, retroperitoneal
hematoma, and intrathecal injection of local anesthetic. In rare instances the LP block can
also lead to motor blockade, interfering with early ambulation. There are several case
reports of Quadratus Lumborum inter-fascial block (QL3) giving equally adequate pain relief
after total hip replacement surgery, and this QL3 block is performed routinely at this
institution. The benefits to inter-fascial administration of local anesthetic include the
avoidance of theoretical nerve injury, bleeding and intrathecal anesthetic administration
associated with the direct interaction between the nerve and the nerve block needle. The
purpose of this study is to show that QL3 block is non-inferior to the standard-of-care
lumbar plexus block and should be used more regularly in hip replacement surgery. The study
will be conducted as a prospective, randomized (1:1), double-blind, non-inferiority,
active-comparator trial. The investigators plan to enroll 40 subjects, 20 in each treatment
group. This study will prospectively investigate the efficacy of QL3 versus Classic LP block
for post-operative pain management in subjects undergoing primary, unilateral hip replacement
surgery and prospectively compare QL3 versus Classic LP block in time to mobilization and
physical therapy response. Primary outcome measures include pain at rest and with movement at
6, 12 and 24 hours after surgery. Secondary outcomes will be time for first request for pain
medication, total pain medications (narcotics and non-narcotic analgesics) given in 24 hours
and the time of participant's ability to walk 100 feet as recorded by a physical therapist.