Erector Spinae Block Versus PENG Block for Hip Replacement

Study Overview
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Brief Summary
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THR (Total Hip Replacement) can be very painful and regional anesthesia is very effective in reducing postoperative pain. Erector Spinae Plane Block (ESPB) and PENG (pericapsular nerve group block) are alternative approaches to the hip sensitive nerve branches that resulted to be very promising for hip surgeries. However, no studies investigated the analgesic superiority of either PENG or ESPB. In our study the investigators compare PENG (with a lateral femoral cutaneous nerve block) and ESPB in terms of pain relief expressed as morphine consumption in the first 24 hours after primary THR.

Official Title
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Erector Spinae Block Versus PENG Block for Postoperative Analgesia After Total Hip Replacement

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: ERECTOR SPINAE PLANE BLOCK
* Procedure: Peng block + lateral femoral cutaneous nerve block
* Procedure: spinal anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary total hip replacement informed consent Exclusion Criteria: allergies to study drugs spinal anesthesia contraindicated kidney failure epilepsy, psychiatric disease, neurologic deficits revision surgery neuropathies in the lumbar area no informed consent pregnancy alcohol/opioid abuse emergency surgery/intensive care

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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: ERECTOR SPINAE PLANE BLOCK<br>ultrasound guided block at L4 | Procedure: ERECTOR SPINAE PLANE BLOCK<br>* ULTRASOUND GUIDED - ROPIVACAINE 30 ml 0.5%<br>Procedure: spinal anesthesia<br>* bupivacaine 0.5% 2.2 ml<br>|
| Active Comparator: PERICAPSULARE NERVE GROUP AND LATERAL FEMORAL CUTANEOUS NERVE BLOCK<br>ultrasound guided block below the ileo-psoas muscle tendon, above the ilio-pectineous eminence and ultrasound guided block of lateral femoral cutaneous nerve | Procedure: Peng block + lateral femoral cutaneous nerve block<br>* ULTRASOUND GUIDED - ROPIVACAINE 20 ml 0.5% + 10 ml 0.5%<br>Procedure: spinal anesthesia<br>* bupivacaine 0.5% 2.2 ml<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| morphine consumption | milligrams of morphine by patient controlled analgesia intravenously | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain | numeric rating scale - NRS 11 point scale from 0 = no pain to 10 = worst imaginable pain | 48 hours | 
| neuropathic pain | DN4 questionnaire - 4 items questionnaire to investigate the occurrence of neuropathic component | 48 hours | 
| postoperative complications | nausea, vomiting, vertigo, blurred vision, syncope, bleeding, falls | 48 hours | 
| chronic postoperative pain | numeric rating scale 11 point scale from 0 = no pain to 10 = worst imaginable pain | 3 months |