{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:47:31Z","timestamp":1782906451637,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":180,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anesthesiology Research and Practice"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Background<\/jats:title>\n Enhanced recovery after surgery (ERAS) is a current concept in surgery that has excellent short\u2010term outcomes. Currently, no standardized ERAS protocol exists for total hip replacement (THR). So, we conducted this study to assess the efficacy of ultrasound\u2010guided erector spinae plane block (ESPB) with dexmedetomidine as an additive in comparison with intrathecal morphine (ITM) for ERAS after THR in Cairo University hospitals.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Our randomized controlled study included 70 patients. The patients were randomly allocated to the M group or E group. M group patients received 5\u2009mL of subcutaneous lidocaine 1% and then 3.5\u2009mL of hyperbaric bupivacaine 0.5% with 0.1\u2009mg of morphine in 0.25\u2009mL of normal saline intrathecally. E group patients received ESPB with dexmedetomidine as an additive on the side of surgery and then 3.5\u2009mL of hyperbaric bupivacaine 0.5% with 0.25\u2009mL 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).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean time of a successful walking trial with a walker of the E group was 12.69\u2009\u00b1\u20092.42\u2009h which is decreased significantly in comparison to the M group (19.71\u2009\u00b1\u20093.11\u2009h), with a mean difference of 7.0 (95% CI 8.81\u20135.2) hours, with a very large effect size (Cohen\n \u2019<\/jats:sup>\n s\n d<\/jats:italic>\n \u2009=\u20092.51), and\n p<\/jats:italic>\n value < 0.001. The mean number of failed walking trials in the E group (1.11\u2009\u00b1\u20090.4 trials) decreased to a statistically significant value in comparison to the mean number of failed walking trials in the M group (2.29\u2009\u00b1\u20090.52 trials), with a mean difference of 1.18 (95% CI 0.96\u20131.4) trials, and\n p<\/jats:italic>\n 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\u2009\u00b1\u20090.59 and 2.51\u2009\u00b1\u20090.51\u2009days, respectively) with a large effect size (Cohen\n \u2019<\/jats:sup>\n s\n d<\/jats:italic>\n \u2009=\u20091.54) and\n p<\/jats:italic>\n value < 0.001. There was no significant difference regarding the mean time of the first morphine dose in M and E groups (16.8\u2009\u00b1\u20094.78\u2009h and 18.86\u2009\u00b1\u20094.63\u2009h, respectively) and\n p<\/jats:italic>\n value\u2009=\u20090.072. Total morphine consumption in the first 24\u2009h was insignificantly higher in the M group than in the E group (7.36\u2009\u00b1\u20092.97\u2009mg and 5.76\u2009\u00b1\u20092.88\u2009mg, respectively), with a mean difference of \u22121.6 (95% CI \u22122.99 to \u22120.2) mg and\n p<\/jats:italic>\n value\u2009=\u20090.025. 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\n p<\/jats:italic>\n 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\u201311.25) and\n p<\/jats:italic>\n value\u2009=\u20090.008.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n \n Trial Registration:<\/jats:bold>\n ClinicalTrials.gov Protocol Registration and Results System: NCT06621849\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1155\/anrp\/9919921","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:05:52Z","timestamp":1782903952000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8093-1288","authenticated-orcid":false,"given":"Ayman Mohamed Hussam Al-din Abd","family":"Al-latif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2545-525X","authenticated-orcid":false,"given":"Ahmed Abdelhamed","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-0795","authenticated-orcid":false,"given":"Osama Mohamed Asaad","family":"Farahat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0860-8523","authenticated-orcid":false,"given":"Atef Kamel Salama","family":"Salem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9142-7561","authenticated-orcid":false,"given":"Karim Hussein Mourad","family":"Ghaleb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.accpm.2015.08.001","article-title":"The Perioperative Surgical Home: An Innovative, Patient-Centred and Cost-Effective Perioperative Care Model","volume":"35","author":"Desebbe O.","year":"2016","journal-title":"Aaesthesia Critical Care and Pain Medicine"},{"key":"e_1_2_10_2_2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1080\/17453674.2017.1410958","article-title":"Outpatient Total Hip and Knee Arthroplasty: Facts and Challenges","volume":"89","author":"Vehmeijer S. B. W.","year":"2018","journal-title":"Acta Orthopaedica"},{"key":"e_1_2_10_3_2","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1093\/pm\/pnaa243","article-title":"Replacement of Fascia Iliaca Catheters With Continuous Erector Spinae Plane Blocks Within a Clinical Pathway Facilitates Early Ambulation After Total Hip Arthroplasty","volume":"21","author":"Xu L.","year":"2020","journal-title":"Pain Medicine"},{"key":"e_1_2_10_4_2","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s00132-019-03697-7","article-title":"Fast-Track-Strategien in Der H\u00fcftendoprothetik","volume":"48","author":"N\u00f6th U.","year":"2019","journal-title":"Orthop\u00e4de"},{"key":"e_1_2_10_5_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2106\/JBJS.H.00079","article-title":"Continuous Lumbar Plexus Block for Postoperative Pain Control After Total Hip Arthroplasty: A Randomized Controlled Trial","volume":"91","author":"Marino J.","year":"2009","journal-title":"Journal of Bone and Joint Surgery"},{"key":"e_1_2_10_6_2","unstructured":"https:\/\/ctv.veeva.com\/study\/effect-of-unilateral-erector-spinae-plane-block-versus-intrathecal-morphine-on-early-mobilization-af."},{"key":"e_1_2_10_7_2","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9113600","article-title":"Fixed Dose Versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial","volume":"9","author":"Bia\u0142owolska K.","year":"2020","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_10_8_2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1093\/bja\/aet248","article-title":"Postoperative Pain Relief After Total Hip Arthroplasty: A Randomized, Double-Blind Comparison Between Intrathecal Morphine and Local Infiltration Analgesia","volume":"111","author":"Kuchalik J.","year":"2013","journal-title":"British Journal of Anaesthesia"},{"key":"e_1_2_10_9_2","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinane.2017.11.006","article-title":"Ultrasound Guided Erector Spinae Plane Block at L-4 Transverse Process Level Provides Effective Postoperative Analgesia for Total Hip Arthroplasty","volume":"44","author":"Tulgar S.","year":"2018","journal-title":"Journal of Clinical Anesthesia"},{"key":"e_1_2_10_10_2","doi-asserted-by":"crossref","first-page":"339","DOI":"10.4103\/0970-9185.83678","article-title":"A Comparative Study of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine","volume":"27","author":"Gupta R.","year":"2011","journal-title":"Journal of Anaesthesiology Clinical Pharmacology"},{"key":"e_1_2_10_11_2","unstructured":"Morphine Sulphate Injection Label 2011 Fda.gov https:\/\/www.accessdata.fda.gov\/drugsatfda."},{"key":"e_1_2_10_12_2","article-title":"An Audit of Sample Sizes for Pilot and Feasibility Trials Being Undertaken in the United Kingdom Registered in the United Kingdom Clinical Research Network Database","volume":"13","author":"Billingham S. A. M.","year":"2013","journal-title":"BMC Medical Research Methodology"},{"key":"e_1_2_10_13_2","article-title":"The Use of Erector Spinae Plane Block Reduces Opioid Consumption and Pain Score in Postoperative Period After Hip Surgery: A Meta-Analysis","volume":"15","author":"Huda A. U.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_10_14_2","doi-asserted-by":"crossref","first-page":"326","DOI":"10.4097\/kja.22669","article-title":"Erector Spinae Plane Versus Fascia Iliaca Block After Total Hip Arthroplasty: A Randomized Clinical Trial Comparing Analgesic Effectiveness and Motor Block","volume":"76","author":"Flaviano E.","year":"2023","journal-title":"Korean Journal of Anesthesiology"},{"key":"e_1_2_10_15_2","doi-asserted-by":"crossref","first-page":"597","DOI":"10.2147\/JPR.S242568","article-title":"Analgesic Efficacy of Erector Spinae Plane Block Compared With Intrathecal Morphine After Elective Cesarean Section: A Prospective Randomized Controlled Study","author":"Hamed M. A.","year":"2020","journal-title":"Journal of Pain Research"},{"key":"e_1_2_10_16_2","doi-asserted-by":"crossref","DOI":"10.14744\/GKDAD.2024.60566","volume-title":"Retrospective Comparison of the Effects of Intrathecal Morphine and Erector Spinae Plane Block on Postoperative Analgesia in Patients Undergoing VATS","author":"Kaya C.","year":"2024"},{"key":"e_1_2_10_17_2","article-title":"Comparison of Intrathecal Morphine Versus Erector Spinae Plane Block for Perioperative Analgesia in Patients Undergoing Lumbar Spine Surgery: A Randomized Control Trial","volume":"16","author":"Lal A.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_10_18_2","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/bja\/aen368","article-title":"Benefit and Risk of Intrathecal Morphine Without Local Anaesthetic in Patients Undergoing Major Surgery: Meta-Analysis of Randomized Trials","volume":"102","author":"Meylan N.","year":"2009","journal-title":"British Journal of Anaesthesia"},{"key":"e_1_2_10_19_2","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-024-02601-x","article-title":"The Efficacy of Lumbar Erector Spinae Plane Block for Postoperative Analgesia Management in Patients Undergoing Lumbar Unilateral bi-portal Endoscopic Surgery: A Prospective Randomized Controlled Trial","volume":"24","author":"Zhao D.","year":"2024","journal-title":"BMC Anesthesiology"},{"key":"e_1_2_10_20_2","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1177\/0310057X1504300405","article-title":"Spinal Anaesthesia With Adjunctive Intrathecal Morphine Versus Continuous Lumbar Plexus Blockade: A Randomised Comparison for Analgesia After Hip Replacement","volume":"43","author":"Fredrickson M. J.","year":"2015","journal-title":"Anaesthesia and Intensive Care"},{"key":"e_1_2_10_21_2","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1111\/anae.15569","article-title":"Efficacy and Safety of Intrathecal Morphine for Analgesia After Lower Joint Arthroplasty: A Systematic Review and Meta\u2010Analysis With Meta\u2010Regression and Trial Sequential Analysis","volume":"76","author":"Gonvers E.","year":"2021","journal-title":"Anaesthesia"},{"key":"e_1_2_10_22_2","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-022-03215-0","article-title":"The Use of Intrathecal Morphine for Acute Postoperative Pain in Lower Limb Arthroplasty Surgery: A Survey of Practice at an Academic Hospital","volume":"17","author":"Sibanyoni M.","year":"2022","journal-title":"Journal of Orthopaedic Surgery and Research"}],"container-title":["Anesthesiology Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/anrp\/9919921","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/anrp\/9919921","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/anrp\/9919921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:06:03Z","timestamp":1782903963000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/anrp\/9919921"}},"subtitle":[],"editor":[{"given":"Xueqin","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/anrp\/9919921"],"URL":"https:\/\/doi.org\/10.1155\/anrp\/9919921","archive":["Portico"],"relation":{},"ISSN":["1687-6962","1687-6970"],"issn-type":[{"value":"1687-6962","type":"print"},{"value":"1687-6970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"9919921"}}