PENG vs. QLB vs. Lumbar ESPB in Total Hip Surgery

Study Overview
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Brief Summary
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The aim of this study is to compare between Pericapsular Nerve Group Block, Erector Spinae Plane Block and Quadratus Lumborum Block for managing acute postoperative pain in patients undergoing total hip surgeries under spinal anesthesia.

Detailed Description
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Total hip surgeries are one of the most common major orthopedic procedures to improve patient's functional status and quality of life. However, despite these advantages, the immediate postoperative period can be associated with severe pain that delays mobilization and increases hospital stay and the risk of thromboembolic events. Various methods are used for postoperative pain management. Intravenous opioid agents are among them, but they may cause undesirable side effects, such as respiratory depression, sedation, constipation, allergic reaction, nausea, and vomiting. Thus, alternative techniques are preferred.

Official Title
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Comparison of Pericapsular Nerve Group Block, Quadratus Lumborum Block and Lumbar Erector Spinae Plane Block for Acute Pain Management in Total Hip Surgery: A Randomized Clinical Trial

Conditions
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Total Hip Surgery, Pericapsular Nerve, Quadratus Lumborum, ESPB

Intervention / Treatment
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* Procedure: PENG block Technique
* Procedure: Lumbar ESPB Technique
* Procedure: Transmuscular QLB-t block Technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-65 years Both genders Body mass index < 40 kg/m^2 American Society of Anesthesiologists (ASA) physical status I-III Posted for total hip surgeries under spinal anesthesia Exclusion Criteria: The presence of contraindications or allergy to local anesthetic agents Chronic use of opioids or corticosteroids Infection at the puncture site Coagulopathy Psychiatric disorders (dementia or cognitive impairment.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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 Technique<br>Patients will receive ultrasound-guided Pericapsular Nerve Group Block using 30 ml bupivacaine 0.25%. | Procedure: PENG block Technique<br>* A linear probe will be used. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, 30 ml of bupivacaine 0.25% will be injected in the plane beneath the iliopsoas muscle<br>|
| Experimental: Lumbar ESPB Technique<br>Patients will receive lumbar erector spinae plane block using 30 ml bupivacaine 0.25% | Procedure: Lumbar ESPB Technique<br>* Using the out-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthetic solution, 30 ml bupivacaine 0.25% will be administered leading to hydrodissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurs when administering local anesthetic . All local anesthetic will be administered to this location between the transverse process and the erector spinae muscle<br>|
| Experimental: Transmuscular QLB-t block Technique<br>Patients will receive transmuscular quadratus lumborum block using 30 ml bupivacaine 0.25% | Procedure: Transmuscular QLB-t block Technique<br>* A convex transducer will be placed in the transverse plane on the flank of the patient cranial to the iliac crest. The 4th lumbar vertebral transverse process, erector spinae muscles, psoas muscle, transverse abdominis muscle, internal and externa oblique muscles, and the quadratus lumborum muscle will be identified. A 15 cm 22G insulated needle will be inserted on the posterior corner of the transducer. 30 ml bupivacaine 0.25% will be administered between the quadratus lumborum and psoas muscles into the fascial plane.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total amount of rescue analgesia | Total amount of rescue analgesia in the form of morphine will be recorded | 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| First analgesic request | The time to first request of rescue analgesia will be recorded | 24 hours Postoperatively | 
| Pain level | Pain level will be evaluated using numeric rating analogue scale (NRS), which ranges from 0 to 10 points, with 0 indicating no pain, 1-3 indicating mild pain, 4-6 indicating moderate pain, and 7-10 indicating severe pain. | 48 hours Postoperatively | 
| Adverse events | Adverse events will be recorded (e.g., nausea, vomiting, hypotension and bradycardia) | 48 hours Postoperatively |