Clinical trial NCT06904703: Pericapsular Nerve Group and Lumbar Erector Spinae Plane Blocks for Geriatrics Undergoing Total Hip Arthroplasty
Official title: Combination of Pericapsular Nerve Group and Lumbar Erector Spinae Plane Blocks for Geriatrics Undergoing Total Hip Arthroplasty Under General Anesthesia: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Pericapsular Nerve
Lumbar Erector Spinae Plane Blocks
Geriatrics
Total Hip Arthroplasty
General Anesthesia
Lead sponsor: Tanta University
Sponsor class: OTHER
First posted: 2025-04-01
Enrollment: 120
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study will be conducted to evaluate the effect of pericapsular nerve group and erector spinae plane block as adjuvants to general anesthesia in geriatrics undergoing total hip arthroplasty.

Detailed description: Total hip arthroplasty is one of the most common major orthopedic procedures to improve a patient's functional status and quality of life. Total hip arthroplasty is one of the most cost-effective and consistently successful surgeries performed in orthopedics and can be associated with significant postoperative pain.

General anesthesia may be considered more versatile and suitable for patients with complex medical histories or those who cannot tolerate spinal anesthesia. However, older patients undergoing hip fracture surgery under general anesthesia may experience a higher risk of postoperative delirium, prolonged sedation, and respiratory complications. Moreover, delayed mobilization is possible, leading to a higher incidence of complications such as deep vein thrombosis and pressure sores.

The target nerves of the hip joint arise from the lumbar plexus (L1-L4), the lumbosacral trunk of the sacral plexus (L4-L5), and the sacral spinal nerves (S1-S4) (7). The femoral nerve, obturator nerve, and the accessory obturator nerve supply the anterior capsule of the hip; the sciatic nerve and the nerve to the quadratus femoris mostly supply the articular branches to the posterior capsule of the hip joint The erector spinae plane block is a novel inter-fascial plane block targets the dorsal and ventral rami of the spinal nerves, is a newer regional anesthetic technique that can be used to provide analgesia for a variety of surgical procedures or to manage acute or chronic pain. This block can potentially provide analgesia to the posterior pelvis potentially safer alternative to epidural or paravertebral techniques, areas often involved in hip fracture pain.

The pericapsular nerve group block targets the articular branches of the femoral and obturator nerves near the hip joint capsule. By blocking these nerves, the pericapsular nerve group block effectively provides analgesia to the hip joint, particular tissues, and proximal femur.

Eligibility criteria: Inclusion Criteria:

* Aged \>75 years.
* Both sexes.
* American Society of Anesthesiologists (ASA) classification I-III.
* Undergoing total hip arthroplasty under general anesthesia.

Exclusion Criteria:

* Patient refusal.
* Body mass index (BMI) \> 30 kg/m2.
* Allergy to local anesthesia drugs.
* Infection at the site of intervention.
* Coagulopathies.
* Preexisting advanced diseases of the kidney or liver.

Primary outcomes:
measure: Mean sevoflurane MAC to achieve bispectral index (BIS) values (45-55)
timeFrame: Intraoperatively
Secondary outcomes:
measure: Pain degree
timeFrame: 24 hours postoperatively
measure: Fentanyl consumption.
timeFrame: Intraoperatively
measure: Arterial blood pressure
timeFrame: Till the end of surgery (up to 2 hours)
measure: Heart rate
timeFrame: Till the end of surgery (up to 2 hours)
measure: Total postoperative morphine consumption.
timeFrame: First 24 hours after surgery
measure: Patient satisfaction
timeFrame: 24 hours after surgery
measure: Complications
timeFrame: 24 hours Postoperatively
Other outcomes:
Locations:
city: Tanta
country: Egypt
facility: Faculty of Medicine
Study officials:
References: