Clinical trial NCT06653894: Postoperative Analgesic Efficacy of PENG and QLB Blocks in Hip Surgeries
Official title: Evaluation of the Postoperative Analgesic Efficacy of Pericapsular Nerve Group (PENG) Block and Quadratus Lumborum Block (QLB) in Hip Surgeries
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hip Surgery
Postoperative Analgesia
Keywords: PENG
QLB
Postoperative Analgesia
Hip Surgery
Lead sponsor: Gaziosmanpasa Research and Education Hospital
Sponsor class: OTHER_GOV
First posted: 2024-10-22
Enrollment: 73
Sex: ALL
Minimum age (years): 40
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This prospective, randomized, single-blinded study compares the postoperative analgesic efficacy of the Pericapsular Nerve Group (PENG) block and Quadratus Lumborum Block (QLB) in hip surgeries under spinal anesthesia. the study focuses on time to first rescue analgesia and total analgesic consumption within the first 48 hours postoperatively in patients over 40 years undergoing elective hip surgery. Ninety patients will be randomized into two groups (PENG or QLB) using a sealed envelope method. The study will assess pain scores, opioid consumption, and side effects, hypothesizing that both blocks provide effective analgesia but seek to identify which offers superior efficacy. Statistical analysis will be performed with SPSS, aiming to contribute valuable insights into analgesic techniques for hip surgeries.

Detailed description: This is a prospective, randomized single-blinded study comparing the postoperative analgesic efficacy of Pericapsular Nerve Group (PENG) block and Quadratus Lumborum Block (QLB) in hip surgeries performed under spinal anesthesia. The study aims to evaluate key outcomes such as the time to first rescue analgesia and total analgesic consumption within the first 48 hours postoperatively. The primary population includes patients over 40 years undergoing elective hip surgery with specific inclusion and exclusion criteria. ninety patients will be divided into two groups, receiving either QLB or PENG block, using a sealed envelope randomization method.

PENG block targets specific nerves to provide analgesia without motor block, preserving motor function. QLB involves injecting a local anesthetic into the fascia near the quadratus lumborum muscle to block thoracoabdominal nerves and provide broad analgesia. Data on pain scores (NRS), opioid consumption, and side effects will be collected at different time points.

The study hypothesizes that both blocks can provide effective postoperative analgesia, with potential benefits such as reduced opioid consumption , but aims to determine which block is superior in efficacy.

The primary aim of this study was to compare the effect of an anterior QLB and PENG block on total opioid analgesic consumption within the first 48 hours postoperatively. The secondary aims were to compare the resting and dynamic NRS scores at 2, 12, 24 and 48 hours postoperatively, the time to first rescue analgesia, and side effects such as nausea, vomiting and quadriceps weakness.

Statistical analysis will be conducted using SPSS, and findings will contribute to the literature on analgesia techniques for hip surgeries.

Eligibility criteria: Inclusion Criteria:

* "Patients aged over 40 years who are scheduled to undergo hip surgery under spinal anesthesia and classified as ASA 1-3 will be included in the study."

Exclusion Criteria:

* Patients who refuse the procedure.
* Patients who will receive general anesthesia or peripheral nerve blocks such as a combination of femoral and sciatic nerve blocks.
* A history of allergy to local anesthetic agents.
* Patients with dementia.
* Patients with multiple trauma.
* Patients with severe hearing or vision impairments.
* Patients with a local infection at the site of the block application.
* Patients with a Body Mass Index (BMI) \> 30.
* Patients with a history of severe neurological, cardiovascular, renal, or hepatic disease will be excluded from the study.

Primary outcomes:
measure: Total Opioid Consumption
timeFrame: 48 hour
Secondary outcomes:
measure: Adverse Events
timeFrame: 48 hour
measure: Numerical Rating Scale (NRS) Scores
timeFrame: 48 hour
measure: Time to First Rescue Analgesic
timeFrame: 48 hours
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: Gaziosmanpasa Research and Education Hospital
Study officials:
References:
citation: Stuart Green M, Ryan Hoffman C, Iqbal U, Olabisi Ives O, Hurd B. Transmuscular Quadratus Lumborum Block Reduces Length of Stay in Patients Receiving Total Hip Arthroplasty. Anesth Pain Med. 2018 Nov 20;8(6):e80233. doi: 10.5812/aapm.80233. eCollection 2018 Dec.
citation: Farag A, Hendi NI, Diab RA. Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis. J Anesth. 2023 Feb;37(1):138-153. doi: 10.1007/s00540-022-03129-5. Epub 2022 Nov 7.
citation: Zheng J, Pan D, Zheng B, Ruan X. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Reg Anesth Pain Med. 2022 Mar;47(3):155-160. doi: 10.1136/rapm-2021-103228. Epub 2021 Dec 6.