Combined Lumbar Erector Spinae Plane Block and Pericapsular Nerve Group Block in Patients Undergoing Hip Surgeries
Condition: Lumbar Erector Spinae Plane Block; Pericapsular Nerve Group Block (PENG Block)
Study type: Interventional
Phase: Phase 4

Summary: 
      The investigators are going to evaluate the postoperative analgesic efficacy of combined
      LESPB and PENG block after hip surgeries.
    

Detailed description: 
      Hip surgeries are very common surgeries and has high postoperative pain potential. There are
      different ways to execute postoperative analgesia and each of them has advantages and
      disadvantages. As the patients submitted to this procedure are usually older and with
      multiple comorbidities, analgesia options with better profile of adverse effects should be
      preferred. Peripheral nerve block with long-acting local anesthetics is very suitable in this
      situation, in comparison with systemic or neuraxial opioids.

      Pain control after total hip arthroplasty (THA) can be challenging because of complex
      innervation of the hip joint from both the lumbar and sacral nerve plexus. pain was the cause
      of 12% of unplanned hospital patient admissions, 60% of these patients were admitted for
      orthopedic concerns. The consequences of severe postoperative pain are prolonged hospital
      stay, increase hospital readmission, precipitation in the use of opioids with subsequent
      increase in postoperative nausea and vomiting, and overall low patient satisfaction.
      Furthermore, postoperative pain can seriously impact the physical and mental health of the
      patient and lead to secondary complications such as nausea, vomiting, slowed bowel movements,
      muscle spasms, thrombosis, cardiopulmonary complications and delayed recovery of organ
      functions.

      The hip joint is innervated by the articular branches of multiple nerves that emerge from the
      lumbosacral plexus (L2-S1). The nerve supply to a specific region of the joint typically
      corresponds to the innervation of the muscle that crosses it :-

        -  The femoral nerve innervates the anterior aspect

        -  The obturator nerve supplies the inferior aspect

        -  The superior gluteal nerve supplies the superior aspect

        -  The nerve to the quadratus femoris innervates the posterior aspect.

      Hip joint capsular innervation was found to consistently involve the femoral and obturator
      nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which
      supplies the posterior capsule.

      Lumbar erector spinae plane block (LESPB) local anesthetics spread to lumbar paravertebral
      space and lumbar nerve roots, reaching the nerves responsible for the innervation of the hip
      joint lumbar plexus nerves - femoral, obturator and lateral femoral cutaneous nerves -
      providing analgesia for hip surgery. LESPB can be a block easier to perform than other
      options for hip surgery analgesia, such as posterior lumbar plexus.

      (L-ESPB) is an effective analgesic technique after hip surgeries. However, an insufficient
      sensorial blockade of the medial part of the thigh which is innervated by the obturator
      nerve.

      The pericapsular nerve group (PENG) block is an ultrasound-guided approach, first described
      by Giron-Arango et al. for the blockade of the articular branches of the femoral, obturator
      and accessory obturator nerves that provide sensory innervation to the anterior hip capsule.
      It has been successfully used as an alternative regional anaesthesia technique for the
      management of acute pain after hip fracture, but its applications are expanding, suggesting a
      potential role for analgesia after elective hip surgery.

      After all the investigators hypothesize that combination of LESPB and PENG block can be more
      effective in pain control after hip surgeries.
    

Intervention name(s): Ultrasound guided L-ESPB and PENG block using Bupivacaine; Postoperative conventional analgesia in form of Acetaminophen
Intervention type(s): Procedure; Drug
Intervention description(s): Combined Lumbar Erector Spinae Plane Block and Pericapsular Nerve Group Block in Patients Undergoing Hip Surgeries; Postoperative conventional analgesia in form of acetaminophen 15 mg/kg/6hrs
Other intervention name(s): Lumbar Erector Spinae Plane Block and Pericapsular Nerve Group Block; Conventional analgesia
Intervention MeSH terms: Acetaminophen; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar Erector Spinae Plane Block; Pericapsular Nerve Group Block; Hip Surgeries; L-ESPB; PENG block