Comparison of Femoral and Obturatory Nerve Joint Branches Conventional Radiofrequency Thermocoagulation ,Intraarticular Steroid Injection and Pericapsular Nerve Group (PENG) Block in Chronic Hip Pain

Study Overview
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Brief Summary
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In this study ,the investigators aimed to show the decrease in pain levels and the effect on quality of life of patients who underwent chronic hip painRFT , intraartıcular steroid injection and Peng block.

Detailed Description
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Hip pain is a common medical condition with increasing age.The effectiveness of conservative methods used in hip pain is limited.Since the lifespan of prostheses used in hip surgery is limited, new methods are needed in the treatment of pain.The anterior sensory innervation of the hip joint is provided by the articular branches of the femoral and obturatory nerve. Today, the most commonly used techniques for hip pain are corticosteroid administration into the hip joint, pericapsular nerve group (PENG) block application, and radiofrequency thermocoagulation to the articular branches of the femoral and obturatory nerves. The aim of this study is to compare the effects of these three procedures in hip pain.

Official Title
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Comparison of Femoral and Obturatory Nerve Joint Branches Conventional Radiofrequency Thermocoagulation ,Intraarticular Steroid Injection and Pericapsular Nerve Group (PENG) Block in Chronic Hip Pain

Conditions
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Chronic Hip Pain

Intervention / Treatment
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* Procedure: radiofrequency thermocoagulation to the articular branches of the femoral and obturatory nerves
* Procedure: intraairticular steroid injection
* Procedure: pericapsular nerve group (PENG) block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be over 18 years old Written consent has been obtained Those with chronic hip pain for more than 3 weeks Exclusion Criteria: Major psychiatric illness The patient has lumbar compression pain or referred pain Patients using anticoagulant agents Patients with infection in the area to be treated Those who are allergic to local anesthetics Those who are allergic to betamethasone Pregnancy Patients who underwent hip surgery during the 3-month follow-up period during the study

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: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: radiofrequency thermocoagulation to the articular branches of the femoral and obturatory nerves<br>radiofrequency thermocoagulation to the articular branches of the femoral and obturatory nerves applied | Procedure: radiofrequency thermocoagulation to the articular branches of the femoral and obturatory nerves<br>* Patients are operated under sedation in the operating room. C-arm fluoroscopy device is used for imaging purposes for radiofrequency thermocoagulation process. In order to prevent vascular injury, the needle is advanced under the guidance of ultrasonography. There are target points determined in fluoroscopy for the femoral nerve and the obturatory nerve. Before the thermocoagulation procedure, local anesthetic and steroid are injected into each of the target points.<br>|
| Active Comparator: intraairticular steroid injection<br>intraairticular steroid injection applied | Procedure: intraairticular steroid injection<br>* The patients were placed in the supine position in the operating room. The patient was stained sterile with povidone iodide. The femoral neck was detected under ultrasonography and the joint capsule was entered with a 22G 9 cm spinal needle. Then, 5 cc bupivacaine and 5 mg betamethasone were given and the procedure was terminated.<br>|
| Active Comparator: pericapsular nerve group (PENG) block<br>pericapsular nerve group (PENG) block applied | Procedure: pericapsular nerve group (PENG) block<br>* The patients were placed in the supine position in the operating room. The patient was stained sterile with povidone iodide. The high-frequency linear ultrasonography probe was placed on the anterior superior iliacspina (ASIS). Later, the anterior inferior iliac spine (AIIS) was detected by descending caudally. Afterwards, the probe was brought to the oblique position and AIIS, iliopubikeminence, psoas muscle and tendon were seen. Using a 22G 90-mm Quinckespinal needle, the tendon of the iliopsoas muscle was entered in the lateral-medial direction in the in-plane plane and bone contact was achieved. After negative aspiration, 15 ml of 0.5% bupivacaine were administered by seeing the appropriate drug distribution.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS(Numerating Rating Scale) for chronic pain | İt is a pain intensity determination system based on the system where there person tells a point between 0=(no pain) 10=( unbearable pain) and to describe their pain | preoperative | 
| NRS(Numerating Rating Scale) for chronic pain | İt is a pain intensity determination system based on the system where there person tells a point between 0=(no pain) 10=( unbearable pain) and to describe their pain | Postoperative first month | 
| NRS(Numerating Rating Scale) for chronic pain | İt is a pain intensity determination system based on the system where there person tells a point between 0=(no pain) 10=( unbearable pain) and to describe their pain | Postoperative third month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| WOMAC (Western OntarioandMcMasterUniversitiesArthritisIndex ) | It includes 24 questions under three sub-headings as pain, stiffness and physical function. Each question was scored according to the Likert scale as 0=absent, 1=mild, 2=moderate, 3=severe, 4=very severe.minimum score is 0=good maximum score is 96 = bad functional capacity | Preoperative | 
| WOMAC (Western OntarioandMcMasterUniversitiesArthritisIndex ) | It includes 24 questions under three sub-headings as pain, stiffness and physical function. Each question was scored according to the Likert scale as 0=absent, 1=mild, 2=moderate, 3=severe, 4=very severe.minimum score is 0=good maximum score is 96 = bad functional capacity | Postoperative first month | 
| WOMAC (Western OntarioandMcMasterUniversitiesArthritisIndex ) | It includes 24 questions under three sub-headings as pain, stiffness and physical function. Each question was scored according to the Likert scale as 0=absent, 1=mild, 2=moderate, 3=severe, 4=very severe.minimum score is 0=good maximum score is 96 = bad functional capacity | Postoperative third month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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femoral and obturatuar nerve, chronic hip pain, Radiofrequency thermocoagulation, intraartıcular steroid injection, pericapsular nerve group (PENG) block