PENG vs Intra-articular Injection for Hip Arthroscopy

Study Overview
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Brief Summary
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Hip arthroscopy is a popular surgical method that is increasingly being used for both intraarticular and extraarticular hip surgeries. Postoperative acute pain is difficult to control in hip surgeries due to the complex nature of hip innervation and the large number of surgical interventions. Optimal treatment of postoperative pain in hip arthroscopy is very important to be able to perform rehabilitation, avoid opioid side effects and minimize unplanned re-hospitalization. Regional anesthesia techniques are widely used because of their proven efficacy in post-surgical pain management and their safety profile that ultimately contributes to early recovery. Many regional techniques such as neuraxial blocks, lumbar plexus block, femoral nerve block, fascia iliac block and intraarticular local anesthetic injection have been used for the treatment of acute postoperative pain. Femoral nerve and fascia iliac blocks have shown good results for long-term post-surgery analgesia. However, the obturator nerve and accessory obturator nerve should be targeted to achieve more effective perioperative pain control. There are studies reporting that pericapsular nerve group block (PENG), which has been defined in recent years, provides effective perioperative analgesia in hip surgeries. In this study, we aim to compare the effectiveness of PENG block and intra-articular local anesthetic injection in hip arthroscopy.

Official Title
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Pericapsular Nerve Group (PENG) Block Versus Intra-articular Injection for Hip Arthroscopy: A Randomized Trial

Conditions
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Opioid Use, Acute Pain

Intervention / Treatment
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* Procedure: Pericapsular nerve group block
* Procedure: Intra-articular local anesthetic injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Association of Anesthesiologists (ASA) physical status I - III BMI 20 to 35 kg / m2 Patients scheduled for elective hip arthroscopy Able to provide informed consent. Exclusion Criteria: Patients who refuse to participate in the study, Coagulopathy, Sepsis, Hepatic or renal insufficiency, Pregnancy Allergy to local anesthetic drugs, Chronic pain condition requiring opioid intake at home, BMI above 40. History of psychiatric diseases needing treatment. Failure of nerve block Substance abuse history Hip revision surgery Underlying neurologic disorder affecting pain perception. Angina, heart attack, heart failure Kidney or hepatic insufficiency Stroke Gastrintestinal bleeding history

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Ultrasound guided pericapsular nerve group block<br>Injection of 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml isotonic saline mixture between iliopubic eminentia and psoas tendon under ultrasound guidance | Procedure: Pericapsular nerve group block<br>* PENG block will be made with 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml NaCl under US-guidance<br>|
| Active Comparator: Intra-articular local anesthetic injection<br>At the end of the surgical case, a total of 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml isotonic saline injection intra-articularly. | Procedure: Intra-articular local anesthetic injection<br>* Intra-articular local anesthetic injection will be made with 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml NaCl<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative opioid consumption | Total amount of morphine consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted. | up to the first 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity score | Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be ) at 0.5, 1, 3, 6, 12, 24 hours postoperatively. | 0.5, 1, 3, 6, 12, 24 hours postoperatively. | 
| First rescue analgesic time | The investigators will collect time to first rescue analgesic consumption in each group | up to the first 24 hours postoperatively | 
| Postoperative nausea and vomiting | Nausea and vomiting intensity score measured by numeric rank score (0:no nausea and no vomiting, 1: have nausea, no vomiting, 2: once vomiting, 3: two or more vomiting). | up to the first 24 hours postoperatively | 
| Patient satisfaction | Patient satisfaction measured using a numeric rating scale 0 to 10 (0 = unsatisfied; 10 =very satisfied) | at the end of 24 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hip arthroscopy, intra-articular injection, PENG block