PENG Block Plus Lateral Femoral Cutaneous Nerve Block for Posterolateral-approached Total Hip Arthroplasty

Study Overview
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Brief Summary
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This study aims to analyze the effect of Pericapsular Nerve Group (PENG) Block combined with lateral femoral cutaneous nerve block vs. PENG block combined with wound infiltration for analgesia after elective hip replacement performed with a posters-lateral approach. Half of participants will receive a PENG Block combined with femoral lateral cutaneous nerve block, while the other half will receive PENG Block combined with wound infiltration

Official Title
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PENG Block Combined to Lateral Femoral Cutaneous Nerve Block vs. PENG Block Combined to Wound Infiltration for Postoperative Analgesia Following Posterolateral-approached Total Hip Arthroplasty

Conditions
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Pain, Postoperative Pain, Acute Pain, Analgesia, Hip Arthropathy, Postoperative Complications

Intervention / Treatment
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* Procedure: PENG Block
* Procedure: Lateral Femoral Cutaneous Nerve Block
* Procedure: Wound Infiltration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elective hip replacement surgery performed with a poster-lateral approach ASA physical status score < 4 Exclusion Criteria: Contraindications to regional anesthesia ASA physical status score ≥ 4 Patient's refusal or inability to sign the informed consent Allergies to any drug provided by the study protocol

Ages Eligible for Study
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Minimum Age: 18 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PENG block plus Femoral Cutaneous Nerve Block<br>Participants receiving PENG block combined to Lateral Femoral Cutaneous Nerve Block | Procedure: PENG Block<br>* At the end of surgery, in Post Anesthesia Recovery Room (PACU), PENG block with 20 mL of 0.5 % Ropivacaine will be executed as described by Giron-Arango et al. using a low frequency curvilinear probe. A 22G 80 mm needle (Stimuplex Ultra 360, B.Braun) will be used.<br>Procedure: Lateral Femoral Cutaneous Nerve Block<br>* At the end of surgery, in Post Anesthesia Recovery Room (PACU), ultrasound guided Lateral Femoral Cutaneous Nerve Block will be performed with 10 mL of 0.5 % Ropivacaine using a high frequency linear probe. A 22G 50 mm needle (Stimuplex Ultra 360, B.Braun) will be used.<br>|
| Active Comparator: PENG block plus Wound Infiltration<br>Participants receiving PENG block combined to wound infiltration | Procedure: PENG Block<br>* At the end of surgery, in Post Anesthesia Recovery Room (PACU), PENG block with 20 mL of 0.5 % Ropivacaine will be executed as described by Giron-Arango et al. using a low frequency curvilinear probe. A 22G 80 mm needle (Stimuplex Ultra 360, B.Braun) will be used.<br>Procedure: Wound Infiltration<br>* At the end of operation, the surgeon will perform wound infiltration with 20 mL of 0.5 % Ropivacaine.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Static Pain Score | A numerical rating scale (NRS) from 0 (no pain) to 10 (worst imaginable pain) will be used to evaluate pain at rest during 24 hours after surgery | 24 hours | 
| Dynamic Pain Score | A numerical rating scale (NRS) from 0 (no pain) to 10 (worst imaginable pain) will be used to evaluate pain on movement during 24 hours after surgery | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | Total of intravenous morphine (expressed in milligrams) administered during the first 24 hours after surgery | 24 hours | 
| Morphine consumption | Total of intravenous morphine (expressed in milligrams) administered during the entire hospitalization | 6 days | 
| Range of hip motion | Degrees of hip flexion | 24 hours | 
| Quadriceps Strength | Ability to flex the knee against gravity | 24 hours | 
| Ability to start physiotherapy during the first postoperative day | YES: the patient was able to start physiotherapy NO: the patient was not able to start physiotherapy during the first postoperative day due to pain or motor block | 24 hours | 
| Ability to ambulate with the help of a walker during the first postoperative day | YES: The patient was able to ambulate with the help of a walker NO: The patient was not able to ambulate with the help of a walker due to pain or motor block | 24 hours | 
| Incidence of block complications | Any complications or side effects of the blocks, such as local infection, intravascular injection of local anesthetics and immediate systemic toxicity. Moreover, incidence of nausea, vomiting and postoperative respiratory depression will be recorded | 24 hours | 
| Hospital Length of Stay | Total Hospital length of Stay (expressed in days) | 6 days |