Ultrasound-Guided Quadro-Iliac Plane Block for Pain Management After Total Hip Arthroplasty

Официальное название

Effectiveness of Ultrasound-Guided Quadro-Iliac Plane Block for Pain Management After Total Hip Arthroplasty: A Prospective Randomized Study

Обзор

This prospective, randomized, double-blind study evaluates the analgesic effectiveness of the ultrasound-guided Quadro-Iliac Plane (QIP) block in patients undergoing primary total hip arthroplasty. The QIP block is a recently described fascial plane block. Patients will be randomized to receive either a QIP block with local anesthetic or a sham block with saline. The primary outcome is 24-hour opioid consumption. Secondary outcomes include motor block, dermatomal sensory assessment, pain scores, rescue analgesic requirement, quality of recovery (QoR-15), and opioid-related side effects.

Подробное описание

Total hip arthroplasty is associated with significant postoperative pain. The Quadro-Iliac Plane (QIP) block is a recently described fascial plane block targeting the area where the quadratus lumborum muscle attaches to the iliac crest and may provide more comprehensive analgesia. This study is designed as a prospective, randomized, double-blind clinical trial including patients aged 18-80 years with ASA physical status I-III undergoing elective primary total hip arthroplasty.

Patients will be randomized into two groups. The QIP group will receive an ultrasound-guided QIP block with 40 mL of 0.25% local anesthetic solution containing epinephrine, and the control group will receive a sham block with 40 mL of 0.9% NaCl using the same technique. The primary outcome is postoperative 24-hour opioid consumption. Secondary outcomes include motor block, and dermatomal sensory assessment, pain scores, quality of recovery (QoR-15), rescue analgesic requirement and opioid-related side effects

Вмешательства

• Процедура Quadro-Iliac Plane (QIP) Block
  An ultrasound-guided Quadro-Iliac Plane block performed in the preoperative period. At the level of the iliac crest, 40 mL of a solution containing 0.25% levobupivacaine and 5 µg/mL epinephrine is injected into the fascial plane between the erector spinae muscle and the quadratus lumborum muscle under aseptic conditions.
• Процедура Sham Block
  A sham block performed using the same ultrasound-guided technique in the preoperative period. At the level of the iliac crest, 40 mL of 0.9% NaCl is injected into the fascial plane between the erector spinae muscle and the quadratus lumborum muscle under aseptic conditions.

Первичные конечные точки

• Postoperative 24-Hour Morphine PCA Consumption [Срок оценки: Postoperative 24 hours]

Вторичные конечные точки (5)

• NRS Pain Scores at Rest and Movement [Срок оценки: 2, 6, 12, 24, and 48 hours postoperatively]
• QoR-15 Recovery Score [Срок оценки: QoR-15 Recovery Score will be evaluated at the postoperative 48th hour]
• Lower Extremity Muscle Strength Score [Срок оценки: Postoperative 6th and 12th hours]
• Rescue Analgesic Requirement [Срок оценки: Postoperative 0-48 hours]
• Opioid-Related Side Effects [Срок оценки: Postoperative 0-48 hours]

Критерии участия

Критерии включения

• American Society of Anesthesiologists (ASA) classification I-III
• Age between 18 and 80 years
• Patients scheduled for elective primary total hip arthroplasty

Критерии исключения

• Refusal to participate in the study
• Allergy to local anesthetics or opioids
• Known or suspected coagulopathy
• Infection at the injection site
• History of previous hip surgery
• Severe cardiovascular disease
• Liver or kidney failure
• Pregnancy, suspected pregnancy, or breastfeeding
• Severe neurological or psychiatric disorder
• Chronic opioid use

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Четверное слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Bursa City Hospital — Bursa

Публикации

• Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017 Sep 25;10:2287-2298. doi: 10.2147/JPR.S144066. eCollection 2017. PMID 29026331
• Carella M, Beck F, Piette N, Denys S, Kurth W, Lecoq JP, Bonhomme VL. Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial. Reg Anesth Pain Med. 2022 Jun 15:rapm-2021-103427. doi: 10.1136/rapm-2021-103427. Online ahead of print. PMID 35705263
• Marrone F, Sorrentino T, Pullano C, Tulgar S. A novel and feasible option for perioperative analgesia in hip fractures surgery: quadro-iliac plane block. Minerva Anestesiol. 2025 Jun;91(6):592-595. doi: 10.23736/S0375-9393.25.18801-9. Epub 2025 Mar 27. No abstract available. PMID 40145906
• Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Girit M, Akin T, Narayanan M, Alici HA. Ultrasound guided quadro-iliac plane block: another novel fascial plane block. Pain Med. 2024 May 3;25(6):370-373. doi: 10.1093/pm/pnae018. PMID 38459608
• Selvi O, Azizoglu M, Temel G, Tulgar S, Chitneni A, Cinar EN, Ozer Z, Gurkan Y. Translation and Validation of the Turkish Version of the Quality of Postoperative Recovery Score QoR-15: A Multi-Centred Cohort Study. Turk J Anaesthesiol Reanim. 2022 Dec;50(6):443-448. doi: 10.5152/TJAR.2022.21417. PMID 36511494

Идентификаторы

NCT: NCT07410000 · Bursa City Hospital 14

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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