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 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.