Pericapsular Nerve Group (PENG) Block Combined With Periarticular Multimodal Drug Injection (PMDI) Versus Isolated PMDI for Pain Management After Total Hip Arthroplasty: a Randomized Controlled Trial

Study Overview
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Brief Summary
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Adequate pain control after total hip arthroplasty is crucial for early ambulation and patient satisfaction. However, there is no consensus about optimal pain control after post operation. In general, the periarticular multimodal durg injection block has been done for pain control in primary total hip arthroplasty. The pericapsular nerve group (PENG) block has been recently introduced a new technique for blockade of the articular branches of the femoral, obturator and accessory obturator nerves. PENG block is possible to provide sufficient analgesia and preserve lower limb muscle strength. The investigators will compare PENG and PMDI block with isolated PMDI block in patients undergoing total hip arthroplasty.

Official Title
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Pericapsular Nerve Group (PENG) Block Combined With Periarticular Multimodal Drug Injection (PMDI) Versus Isolated PMDI for Pain Management After Total Hip Arthroplasty: a Randomized Controlled Trial

Conditions
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Total Hip Arthroplasty, Postoperative Pain

Intervention / Treatment
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* Procedure: Pericapsular nerve group(PENG) block combined with periarticular multimodal drug injection (PMDI)
* Procedure: isolated periarticular multimodal drug injection (PMDI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. Patients aged 19 years old or older, with American Society of Anesthesiologists Physical Status 1-3, and scheduled for elective unilateral total hip arthroplasty Exclusion Criteria: Allergy or intolerance to any of the drugs used in the study Hepatic or renal insufficiency Opioid dependency Coagulopathy Pre-existing neurologic or anatomic deficits in the lower extremities Severe psychiatric illness

Ages Eligible for Study
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Minimum Age: 19 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pericapsular nerve group(PENG) block combined with periarticular multimodal drug injection (PMDI)<br>Participants receiving pericapsular nerve group(PENG) block combined with periarticular multimodal drug injection (PMDI) | Procedure: Pericapsular nerve group(PENG) block combined with periarticular multimodal drug injection (PMDI)<br>* periarticular local anesthetic infiltration with 120 mg of ropivacaine, epinephrine 0.2 mg and 30 mg of ketorolac diluted with normal saline to a total volume of 40 mL. + PENG block with ropivacaine 40 mg and epinephrine 0.1 mg with normal saline to a total volume of 20 mL<br>* Other names: PENG + PMDI block;|
| Active Comparator: isolated periarticular multimodal drug injection (PMDI)<br>Arm Description: Participants receiving isolated periarticular multimodal drug injection (PMDI) | Procedure: isolated periarticular multimodal drug injection (PMDI)<br>* periarticular local anesthetic infiltration with 150 mg of ropivacaine, epinephrine 0.3 mg and 30 mg of ketorolac diluted with normal saline to a total volume of 50 mL<br>* Other names: Isolated PMDI block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric rating scale pain score | Pain intensity at rest evaluated by an 11-point numeric rating scale (NRS: 0 = no pain, 10 = worst imaginable pain) at 24 hours postoperatively | at 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain score measured at 6 hours postoperatively and 48 hours postoperatively | Pain intensity at rest evaluated by an 11-point numeric rating scale (NRS: 0 = no pain, 10 = worst imaginable pain) at 6 hours postoperatively and 48h postoperatively | Pain score measured at 6 hours postoperatively and 48 hours postoperatively |