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Total hip arthroplasty (THA) is one of the most successful orthopedic procedures to effectively relieve pain and restore function in patients with hip osteoarthritis, osteonecrosis of femoral head and hip fracture.The Lumbar Plexus Block (LPB) is currently used as the standard regional anesthesia technique to provide postoperative pain management after THA. The lumbar plexus (LP) originates from T12 to L5. In general, multiple-needle nerve blockade procedure is needed to block different branches of LP. Therefore, we need more time to finish the regional anethesia procedure and it's not easy for an inexperienced anesthesiologist to master the technique absolutely. In addition, multiple injections will increase the discomfort of the patients. We aim to investigate the effects of lumbar plexus combined with quadratus lumborum block using single-needle technique with Shamrock method as an alternative regional anesthesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| L3 LPB technique (P group) | Active Comparator | ultrasound-guided shamrock approach L3 lumbar plexus block with single-needle technique |
|
| T12 combined with L3 and L4 LPB technique (TP group) | Active Comparator | ultrasound-guided posterior approach thoracic 12 combined with L3 and L4 lumbar plexus block with mulitple-needle technique |
|
| L3 LPB combined with QLB (LPQLB-SNT, PQ group) | Experimental | ultrasound-guided shamrock approach L3 lumbar plexus block combined with quadratus lumborum block with single-needle technique |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| L3 LPB | Procedure | ultrasound-guided L3 lumbar plexus block |
|
| Measure | Description | Time Frame |
|---|---|---|
| sensory block assessment | The sensory block will be assessed by cold alcohol swab and pinprick at lateral, anterior and medial areas of thigh and postero-lateral area of gluteus using a 0 to 2 point scale. 0= no block, patients can feel cold; 1= analgesic block, patient can feel touch but not cold; 2= anesthetic block, patient cannot feel cold or touch. | 30 minutes after nerve block procedure |
| Measure | Description | Time Frame |
|---|---|---|
| postoperative static pain at timepoint 1 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 30mins after the patient recover from general anesthesia |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shanghai Jiao Tong University Affiliated Sixth People's Hospital | Shanghai | Shanghai Municipality | 200233 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41188948 | Derived | Wang X, Zhang J, Xie Z, Chen Y, Yonglin-Chen, Rao Z, Zhang H. Efficacy and safety of combined lumbar plexus and quadratus lumborum block via Shamrock approach at L3 in total hip arthroplasty: a prospective randomized controlled trial. Trials. 2025 Nov 4;26(1):467. doi: 10.1186/s13063-025-09195-w. | |
| 37718446 | Derived |
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Data with patient identification will not be publicly accessible after the study.
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| L4 LPB | Procedure | ultrasound-guided L4 lumbar plexus block |
|
| T12 block | Procedure | ultrasound-guided thoracic 12th segment nerve block |
|
| L3 QLB | Procedure | ultrasound-guided quadratus lumborum block at L3 level |
|
| 0.375%ropivacaine 25 ml (Raropin) | Drug | 0.375%ropivacaine (Raropin) 25ml will be given |
|
| 0.375%ropivacaine 40 ml (Raropin) | Drug | 0.375%ropivacaine (Raropin) 40ml will be given |
|
| General anesthesia with tracheal intubation | Procedure | General anesthesia with tracheal intubation will be induced with sufentanil, propofol, vecuronium for every patient before the operation and maintained with sevoflurane during the operation |
|
| postoperative static pain at timepoint 2 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 6 hours after surgery |
| postoperative static pain at timepoint 3 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 12 hours after surgery |
| postoperative static pain at timepoint 4 | Visual Analog Scale (VAS) score (0-10, 0 means no pain, 10 means the worst pain) of pain at rest will be recorded at several points of time within 24 hours after surgery: 1) 30mins after the patient recover from general anesthesia in postanesthesia care unit (PACU); 2) 6 hours after surgery;3) 12 hours after surgery; 4) 24 hours after surgery | at 24 hours after surgery |
| Performance time of block | Performance time is defined as the time from insertion of the block needle (skin puncture) until finishing local anaesthetic (LA) injection | During nerve block procedure |
| intraoperative sufentanil dosage | The total intraoperative sufentanil dosage will be recorded | during the operation |
| Incidence of block related adverse events | Intraoperative and postoperative adverse events such as vascular puncture, local anesthetic systemic toxicity, epidural spread, etc. | within 24hours after nerve block procedure |
| Cumulative doses of intraoperative vasoactive medications | Cumulative doses of intraoperative vasoactive medications (urapidil, atropine, ephedrine and deoxyepinephrine, etc.) | during the operation |
| Wang X, Zhang H, Chen Y, Xie Z, Chen M, Chen Y, Zhang J. The anesthetic efficacy of ultrasound-guided lumbar plexus combined with quadratus lumborum block with Shamrock approach in total hip arthroplasty: study protocol for a randomized controlled trial. Trials. 2023 Sep 18;24(1):596. doi: 10.1186/s13063-023-07619-z. |
| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| D006620 | Hip Fractures |
| D005271 | Femur Head Necrosis |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
| D007869 | Leg Injuries |
| D010020 | Osteonecrosis |
| D001847 | Bone Diseases |
| D009336 | Necrosis |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D007442 | Intubation, Intratracheal |
| ID | Term |
|---|---|
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D058109 | Airway Management |
| D013812 | Therapeutics |
| D007440 | Intubation |
| D008919 | Investigative Techniques |
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