The Effect of Unilateral Erector Spinae Plane Block With Dexmedetomidine as an Additive Versus Intrathecal Morphine on Early Mobilization After Total Hip Replacement Under Spinal Anesthesia in Cairo University Hospitals: A Randomized Controlled Trial.

BACKGROUND

Enhanced recovery after surgery (ERAS) is a current concept in surgery that has excellent short-term outcomes. Currently, no standardized ERAS protocol exists for total hip replacement (THR). So, we conducted this study to assess the efficacy of ultrasound-guided erector spinae plane block (ESPB) with dexmedetomidine as an additive in comparison with intrathecal morphine (ITM) for ERAS after THR in Cairo University hospitals.

METHODS

Our randomized controlled study included 70 patients. The patients were randomly allocated to the M group or E group. M group patients received 5 mL of subcutaneous lidocaine 1% and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.1 mg of morphine in 0.25 mL of normal saline intrathecally. E group patients received ESPB with dexmedetomidine as an additive on the side of surgery and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.25 mL of normal saline intrathecally. The primary outcome was the time of the first successful walking trial for 10 steps with a walker. Secondary outcomes were postoperative pain score, total morphine consumption, duration of hospital stay, patient satisfaction, and incidence of complications (hypotension, bradycardia, pruritus, nausea, vomiting, and urine retention).

RESULTS

The mean time of a successful walking trial with a walker of the E group was 12.69 ± 2.42 h which is decreased significantly in comparison to the M group (19.71 ± 3.11 h), with a mean difference of 7.0 (95% CI 8.81-5.2) hours, with a very large effect size (Cohen's d = 2.51), and p value < 0.001. The mean number of failed walking trials in the E group (1.11 ± 0.4 trials) decreased to a statistically significant value in comparison to the mean number of failed walking trials in the M group (2.29 ± 0.52 trials), with a mean difference of 1.18 (95% CI 0.96-1.4) trials, and p value < 0.001. Duration of hospital stay after surgery was, on average, 33.9% lower in E group in comparison to M group (1.66 ± 0.59 and 2.51 ± 0.51 days, respectively) with a large effect size (Cohen's d = 1.54) and p value < 0.001. There was no significant difference regarding the mean time of the first morphine dose in M and E groups (16.8 ± 4.78 h and 18.86 ± 4.63 h, respectively) and p value = 0.072. Total morphine consumption in the first 24 h was insignificantly higher in the M group than in the E group (7.36 ± 2.97 mg and 5.76 ± 2.88 mg, respectively), with a mean difference of -1.6 (95% CI -2.99 to -0.2) mg and p value = 0.025. The patient satisfaction score was better in the E Group than in the M Group. The number of patients with complete satisfaction was more in the E group (24 [68.6%]) than in the M group (10 [28.6%]) and p value < 0.001. The rate of complications was higher in the M Group than in E Group (56.19% vs. 22.86%, respectively, with an odds ratio of 4.01 (95% CI, 1.43-11.25) and p value = 0.008.

CONCLUSION

ESPB with dexmedetomidine as an additive enhances early mobilization after THR better than ITM with about a 34% decrease in the duration of hospital stay and a lower rate of complications. Trial Registration: ClinicalTrials.gov Protocol Registration and Results System: NCT06621849.