The PENG Block in Elective Hip Surgery and Its Effect on Postoperative Pain and Length of Stay.
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Effective postoperative pain management in elective hip surgery is crucial for the patients
      well-being, rapid mobilisation and potential reduction of length of stay. In addition to
      standard intravenous pain medication, anaesthetic blocks are reportedly effective. Recently,
      the PENG block, a pericapsular pain block without impairment of the motor function has been
      introduced in literature and performed at the investigator's hospital (HFR Fribourg,
      Switzerland) for total hip arthroplasty and surgical hip dislocation - the two most commonly
      performed elective hip surgeries.

      As high-quality evidence on the effectiveness of this novel block is lacking, the
      investigator's objective is to evaluate the effectiveness of (1) patient-reported pain
      reduction, (2) total consumption of postoperative morphine, and the length of stay at the
      hospital.
    

Detailed description: 
      Forty patients undergoing total hip arthroplasty and 40 patients undergoing surgical hip
      dislocation will be enrolled in a prospective, double-blind, controlled trial performed at
      the investigator's hospital.

      This study will be the first prospective study evaluating the potential of this pain block in
      elective hip surgery potentially affecting both patients' postoperative well-being and
      optimizing costs of the hospital by reducing length of stay.
    

Intervention name(s): PENG block; Placebo
Intervention type(s): Procedure; Procedure
Intervention description(s): All patients will undergo the same preoperative, standardized protocol. Upon arrival to the operating room, patients will be placed in supine position. Routine, standard pre-medication will be applied before induction of general anesthesia. After intubation, the PENG block is performed. Under sonographic guidance using a curvilinear probe, puncture will be performed in a lateromedial direction until the needle tip reaches the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, the blinded test item will be injected in the plane beneath the iliopsoas muscle. Patients will be randomly assigned to receive the test item (20 mL of ropivacaine 0.5%, Naropin). The anesthesiologist and the surgeon are blinded to the product injected.; ll patients will undergo the same preoperative, standardized protocol. Upon arrival to the operating room, patients will be placed in supine position. Routine, standard pre-medication will be applied before induction of general anesthesia. After intubation, the PENG block is performed. Under sonographic guidance using a curvilinear probe, puncture will be performed in a lateromedial direction until the needle tip reaches the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, the blinded test item will be injected in the plane beneath the iliopsoas muscle. Patients will be randomly assigned to receive the placebo (20 mL of NaCL 0.9%). The anesthesiologist and the surgeon are blinded to the product injected.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Interdisciplinary, prospective, double-blind (participant and investigator), placebo-controlled, parallel-group study (experimental study, level of evidence I).
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: PENG block; Postoperative pain; Elective hip surgery; Total hip arthroplasty; Surgical hip dislocation