Periarticular Infiltration of Local Anesthetics Versus Pericapsular Nerve Group Block for Total Hip Replacement
Condition: Postoperative Pain; Weakness, Muscle; Analgesia; Motor Activity
MeSH terms: Muscle Weakness
Study type: Interventional

Summary: 
      This randomized trial is set out to compare the postoperative strength preservation capacity
      of local infiltration anesthesia (LIA) and pericapsular nerve group (PENG) block after
      performing a primary total hip arthroplasty (THA).

      The hypothesis is that LIA represents a superior alternative to PENG block in terms of
      strength preservation but providing effective analgesia during the first 24 postoperative
      hours after THA. Hence, the trial was designed as a superiority study hypothesizing a
      fivefold reduction in quadriceps paresis/paralysis at 3 hours.
    

Detailed description: 
      Patients who agree to participate in the protocol will be assigned to one group or another
      (LIA and PENG) through computationally generated block randomization. Outcome assessors
      blinded to randomization will perform all measurements.

      All blocks, LIA or PENG, will be performed (or supervised) by one of the co-authors, an
      expert orthopedic surgeon or an expert anesthesiologist, respectively. Both blocks will be
      executed in the operating room, on the surgical table, under sedation, and with the barrier
      that separates the surgical field from the cranial area of the patient to keep the latter
      blind to the technique received.

      All patients will undergo spinal anesthesia using 0.5% bupivacaine (10mg) plus 20 μg of
      fentanyl. Both groups will also receive tranexamic acid 1g intravenous (IV), ketoprofen 100mg
      IV, and acetaminophen 1gr IV. Propofol sedation guided with a targeted controlled infusion
      (TCI) model will be administered in order to obtain an adequate level of sedation.

      All surgeries will be conducted by the same team of surgeons, performing a posterior approach
      technique in the lateral decubitus position.

      In the recovery room, all patients will receive patient-controlled analgesia (morphine bolus
      = 1 mg; lockout interval = 8 minutes). On the surgical ward, all subjects will continue to
      receive acetaminophen (1 g per os every 6 hours), ketoprofen (100 mg per os every 8 hours) as
      well and patient-controlled analgesia (morphine bolus = 1 mg IV; lockout interval = 8
      minutes).
    

Intervention name(s): Ultrasound-guided pericapsular nerves group of the hip block; Pericapsular local anesthetic infiltration of the hip
Intervention type(s): Procedure; Procedure
Intervention description(s): After the ultrasound-guided insertion of a block needle at the level of the inguinal ligament, the needle will be advance into the plane between the iliac bone periosteum and the tendon of the iliopsoas muscle in order to inject 20 mL of adrenalized 0.5% bupivacaine.; Intraoperatively, 60 mL of adrenalized 0.25% bupivacaine plus ketorolac 30 mg will be infiltrated by the surgeon.
Intervention MeSH terms: Anesthetics; Anesthetics, Local
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective randomized comparison between two analgesic techniques
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care