Clinical Trials Logo

Clinical Trial Summary

In this prospective and randomized study, we aimed to compare the effect of of three sitting positions (the traditional sitting position (TSP), the harmstring stretch position (HSP), and the squatting position on the success rate of combined spinal epidural anesthesia in patients undergoing total knee arhtoplasty (TKA) or total hip arthroplasty (THA) surgery.


Clinical Trial Description

Positioning of patients plays a major role to identify accurately epidural and/or spinal spaces for neuraxial blocks. Flexed back is considered mandatory to widen the inter spinous space in traditional lateral and sitting positions. In traditional sitting position (TSP), the patient is positioned in a sitting posture on the operating table. A stool is placed by the side of the operating table to support the legs. Both hips and knees are maximally flexed.

In recent years, several studies suggested that the reduction of lumbar lordosis may increase the success rate of spinal or epidural block and reduce needle-bone contact. Different modified sitting positions were described for this aim: the harmstring stretch position (HSP), the squatting position (SP), and the crossed-leg position (CLP).

In modified sitting positions, the patients sit up from supine position with the legs remaining on the operating table, either knees are maximally extended (the harmstring stretch position), or hips and knees are maximally flexed (the squatting position), or hips and knees are flexed with crossing the legs (the crossed leg position). All studies comparing modified sitting positions with TSP found that the success rate and number of needle bone contacts were similar except one study which reported a lower needle bone contact with squatting position. Other factors contributing the success of the neuraxial block were: anatomical landmarks (palpability of the spinous processes, identification of the midline), immobilization of the patient during the injection, and the provider's level of experience.

The combined spinal - epidural (CSE) technique has been increasingly used for over thirty years which consist of intentional injection of a local anesthetic into the subarachnoidal space and the placement of a catheter into epidural space to prolong or modify the block.

Although CSE technique combines the best features of spinal and epidural blockade, it is a more complicated to perform. Studies comparing CSE with epidural and/or spinal technique reported similar failure rates but most of them did not focuse on the effect of patient's positioning.

In this prospective and randomized study, we aimed to compare the effect of of three sitting positions (the traditional sitting position (TSP), the harmstring stretch position (HSP), and the squatting position (SP) on the success rate of CSE anesthesia in patients undergoing total knee arhtoplasty (TKA) or total hip arthroplasty (THA) surgery. The CLSP was not included in the study design because the crossing the legs during the procedure seemed to be painful and difficult in patients with degenerated knee joints.

Our primary endpoint was the number of needle bone contact and the secondary endpoint was ease of needle insertion/space identification. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT03541798
Study type Interventional
Source Diskapi Teaching and Research Hospital
Contact
Status Completed
Phase N/A
Start date May 1, 2019
Completion date December 23, 2019

See also
  Status Clinical Trial Phase
Recruiting NCT05556759 - Anterior Iliopsoas Muscle Space Block Versus Supra-iliac Anterior Quadratus Lumborum Block in Total Hip Arthroplasty N/A
Withdrawn NCT05030688 - Fascia Iliaca Compartment Block and PENG Block for Hip Arthroplasty N/A
Not yet recruiting NCT05015517 - ESP Block vs FIB in Patients Undergoing Hip Arthroplasty N/A
Completed NCT05134207 - The Effect of Oral Carbohydrate Solution on Anxiety and Comfort in Patients Undergoing Hip Arthroplasty N/A
Recruiting NCT04438265 - Quadratus Lumborum Type 2 as Chronic Hip Pain Treatment
Recruiting NCT04229368 - Effect of Vitamin D Status and Repletion on Postoperative Total Joint Arthroplasty Complications N/A
Active, not recruiting NCT05142462 - Post Market Clinical Follow-up of EUROSCUP Fixe Acetabular Cup
Recruiting NCT06083428 - Erector Spinae vs. Iliopsoas Plane Block for Total Hip Arthroplasty Phase 4
Completed NCT05396924 - Rectal Temperature Measurement in Detecting Hypothermia During Hip Arthroscopy N/A
Active, not recruiting NCT05524363 - Assessment of Safety and Performances of HYPE SCS Stem Associated to NOVAE Sunfit TH Acetabular Cup in Hip Arthroplasty
Recruiting NCT06147401 - Comparison of PENG Associated With LFCN Block Versus FICB for Multimodal Analgesic Management in THA N/A
Completed NCT03977454 - Periarticular Injection Versus Peripheral Nerve Block in Total Hip Arthroplasty Phase 2
Recruiting NCT05397145 - Iliopsoas Plane Block vs PENG Block for Hip Arthroplasty N/A
Completed NCT03981354 - Nutritional Status and Its Modifications After Hip Replacement
Active, not recruiting NCT04995822 - Post Market Clinical Follow-up of EUROSTEM Femoral Stem
Completed NCT04883788 - The Impact of COVID-19 Pandemic on Hip and Knee Replacement
Not yet recruiting NCT06317870 - Pericapsular Nerve Block Versus Intrathecal Morphine for Analgesia After Primary Hip Arthroplasty N/A
Completed NCT04306133 - PENG Block Combined to Wound Infiltration for Hip Replacement N/A
Completed NCT04123873 - Effect of Combinations of Paracetamol, Ibuprofen, and Dexamethasone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty Phase 4
Not yet recruiting NCT06233604 - Dexamethasone vs. Dexmedetomidine for ESPB in Pain Management After Hip Arthroplasty Phase 4