Effects of Pericapsular Nerve Group Block on Postoperative Recovery for Total Hip Arthroplasty

Study Overview
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Brief Summary
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The hypothesis of this study is that patients who undergo PENG block in before Total Hip Artroplasthy (THA) surgery with spinal anesthesia will have reduced postoperative pain scores, less need for opioid analgesics and earlier mobilisation.

Detailed Description
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This prospective randomised controlled study included a total of 60 patients aged 40-85 years who underwent THA surgery under spinal anaesthesia. Patients were divided into two groups as PENG block (n:30) and non-PENG block (n:30). PENG block was placed in the fascial plane between the pseudotendon and pubic ramus with USG in-plane technique, 20 ml of 0.5% bupivacaine was administered and surgery was initiated. The primary outcome of the study was to investigate the effect of preoperative PENG block application on postoperative pain, opioid requirement, mobilisation time, hip joint patency and length of hospital stay in patients undergoing THA surgery. The secondary outcome was to investigate the effect of PENG block on perioperative haemodynamics and postoperative side effects. For multimodal analgesia, 10 ml 0.5% bupivacaine + 10 ml 2% lidocaine is infiltrated into the surgical wound incision line by the surgical team at the end of surgery. After tramadol 50 mg loading with PCA device, a basal rate of 5-10 mg/hour (20 mg bolus dose + 30 minutes lock time) is given with paracetamol 10 mg/kg iv (8 hours interval).

Official Title
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Effects of Pericapsular Nerve Group Block on Postoperative Recovery for Total Hip Arthroplasty

Conditions
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Analgesia, Postoperative Pain, Acute

Intervention / Treatment
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* Procedure: Pericapsular Nerve Group (PENG) Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: THA performed by posterior approach 40-85 age range ASA 1-3 Exclusion Criteria: Under 40 years of age, over 85 years of age, ASA 4 and above, Cognitive impairment (Alzheimer's disease, dementia, delirium etc.), Hip fracture, Application site infection, Allergy to local anaesthetic agents, Patients are non-consenting patients.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 85 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
Interventional Model Description: This prospective randomised controlled study included a total of 60 patients aged 40-85 years who underwent THA surgery under spinal anaesthesia. Patients were divided into two groups as PENG block and non-PENG block (control group).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PENG group<br>PENG block was placed in the fascial plane between the pseudotendon and pubic ramus with USG in-plane technique, 20 ml of 0.5% bupivacaine was administered after spinal anaesthesia. | Procedure: Pericapsular Nerve Group (PENG) Block<br>* With ultrasonography-guided PENG block, the femoral, obturator and accessory obturator nerve branches that provide sensory innervation of the anterior surface of the hip joint capsule are blocked .<br>|
| Placebo Comparator: non-PENG group<br>group non-PENG, surgery was started without PENG block after spinal anaesthesia. | Procedure: Pericapsular Nerve Group (PENG) Block<br>* With ultrasonography-guided PENG block, the femoral, obturator and accessory obturator nerve branches that provide sensory innervation of the anterior surface of the hip joint capsule are blocked .<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain score | VAS pain score | recovery room 30 min, 12., 24. and 48. hours in the postoperative period | 
| mobilisation time | walking 5 steps with walker | 24 -48 hours | 
| hip joint patency | Measurement of joint movement angle with goniometer (angle) | 24. hours | 
| total opioid consumption | Tramadol total usage (mg) | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PENG block side effects | motor block, nausea, vomiting, anaphylaxis, nerve damage | The first 48 hours after performing the PENG block | 
| Perioperative haemodynamic data | heart rate, mean arterial pressure | T1: 30 minutes (min) after spinal anesthesia, T2: at the end of the surgical procedure, T3: at 30 minutes after recovery | 
| length of hospital stay | hospitalization and discharge time for surgery | day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multimodal analgesia, pericapsular nerve group block, total hip arthroplasty, spinal anesthesia