Clinical trial NCT05261009: PENG Block Versus LP Block for THA Postop Pain
Official title: PENG Block Versus LP Block for Postoperative Analgesia After Anterior Total Hip
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Pain, Postoperative
Hip Pain Chronic
Lead sponsor: Wake Forest University Health Sciences
Sponsor class: OTHER
First posted: 2022-03-02
Enrollment: 154
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this randomized, double blinded, prospective study is to compare the postoperative analgesia provided by the PENG block to that provided by the LPB for patients undergoing primary anterior approach THA.

Detailed description: Regional anesthesia procedures represent a common modality for postoperative analgesia after total hip arthroplasty surgeries (THA). The standard practice many years has been the Lumbar Plexus block (LPB), which anesthetizes the L1-L5 lumbar nerve roots1. While the LPB offers analgesia from the associated sensory block, it also blocks motor fibers, leading to lower extremity weakness that could potentially delay the patient's ability to participate in early physical therapy and may thereby delay discharge. In the past several years, newer regional anesthesia block approaches have been described and investigated in an attempt to provide patients with postoperative analgesia while avoiding associated muscle weakness, facilitating earlier physical therapy participation and discharge. One such nerve block is the peri-capsular nerve group (PENG) block, which anesthetizes the articular branches of the femoral, obturator, and accessory obturator nerves providing sensory innervation to the hip joint capsule without consistently causing lower extremity weakness2. Some institutions are utilizing the PENG block to provide postoperative analgesia and facilitate early mobilization. There are currently no prospective studies that directly compare the efficacy of LPB to PENG block for providing postoperative analgesia after THA.

Eligibility criteria: Inclusion Criteria:

* elective primary total hip arthroplasty surgery anterior approach
* provided informed consent
* no contraindications to medications used in providing the analgesic blocks

Exclusion Criteria:

* contraindications to regional anesthesia, such as an allergy to amide local anesthetics
* pre-existing coagulopathy or thrombocytopenia \<100,000
* refusal of analgesic block for pain management
* presence of an progressive lower extremity neurological deficit
* localized or systemic infection
* chronic use of high dose opioid analgesics (defined as daily use greater than 60 mg oxycodone equivalents)
* pregnant
* refusal of consent

Primary outcomes:
measure: Numeric Rating Scale (NRS) Pain Score
timeFrame: hour 6
Secondary outcomes:
measure: NRS Pain Score
timeFrame: hour 12
measure: NRS Pain Score
timeFrame: hour 18
measure: NRS Pain Score
timeFrame: hour 24
measure: Time in Minutes Until Opioid Administration
timeFrame: hour 24
measure: Motor Strength
timeFrame: hour 6
measure: Distance Ambulated
timeFrame: hour 24
Other outcomes:
Locations:
city: Winston-Salem
country: United States
facility: Wake Forest Health Sciences
state: North Carolina
Study officials:
affiliation: Wake Forest University Health Sciences
name: Rawad Hamzi, MD
role: PRINCIPAL_INVESTIGATOR
References: