Overview
Diffusion of local anesthetics after a lumbar ESPB within fascial planes towards nerve structures is a matter of debate.
The main objective of the study is to compare the incidence of sensory block between two techniques of needle placement (superficial or translaminar) during lumbar ESPB block.
Patients are treated with lumbar ESPB (randomized to superficial or translaminar), spinal anesthesia and multimodal analgesia.
The primary endpoint will be the incidence of numbness/reduced skin sensitivity to cold (ice test) in the area innervated by the lumbar plexus. Secondary outcomes are pain and analgesic's consumption, motor block, quality of recovery and discharge ability.
Eligibility
Inclusion Criteria:
- primary total hip replacement
- informed consent
Exclusion Criteria:
- allergies to study drugs
- spinal anesthesia contraindicated
- kidney failure (GFR\<30)
- epilepsy, psychiatric disease, neurologic deficits
- revision surgery
- neuropathies in the lumbar area (tingling, hypoestesia, numbness, motor deficit)
- no informed consent
- pregnancy
- alcohol/opioid abuse
- emergency surgery/intensive care
