Clinical trial NCT05654519: Comparison of Pericapsular Nerve Group Block and Quadratus Lumborum Block
Official title: Comparison of Pericapsular Nerve Group Block with Lateral Femoral Cutaneous Nerve Block and Quadratus Lumborum Block for Total Hip Arthroplasty
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Total Hip Surgery
Pericapsular Nerve
Quadratus Lumborum
Keywords: Total Hip Surgery
PENG block
QLB
Lead sponsor: Konya Necmettin Erbakan Üniversitesi
Sponsor class: OTHER
First posted: 2022-12-16
Enrollment: 80
Sex: ALL
Minimum age (years): 40
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Parallel Assignment
Primary purpose: TREATMENT

Brief summary: Adequate pain management following total hip arthroplasty (THA) is a key component for patient satisfaction and early ambulation. However, due to the complexity of the innervation of the hip joint, the most appropriate anaesthetic and analgesic technique for THA remains unclear. A femoral nerve block is commonly performed and well established but is associated with motor weakness. Recently, the pericapsular nerve group (PENG) block has been introduced as an effective choice which targets the articular branches of the hip. The quadratus lumborum block (QLB) is a relatively new regional block that has been reported to provide effective analgesia for THA.

The main objective of this study is to compare the effectiveness of the ultrasound-guided PENG block technique compared to QLB block in terms of efficacy of pain control and the safety profile after total hip arthroplasty under spinal anesthesia.

Detailed description: The patients will be randomly classified into two equal groups (40 patients each). Group allocation will be done by computer generated random numbers and closed opaque sealed envelopes. The study will be designed to be double blind as all patients and outcomes assessor will be blinded to group assignment.

Patients will be randomized to one of three equal groups:

Group I (n= 40 patients): Patients in this group will receive an ipsilateral single shot of QLB (30 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

Group II(n= 40 patients): patients in this group will receive an ipsilateral single-shot of PENG block (25 ml of plain bupivacaine 0.25%) and LFCN block (5 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

Eligibility criteria: Inclusion Criteria:

Physical status according to American Society of Anesthesiologists (ASA ) I-III

Exclusion Criteria:

* Younger than 40 years old and older than 85
* Patients undergoing general anesthesia
* Allergy or intolerance to one of the study medications
* Infection of the skin at the site of the needle puncture,
* Patients who do not accept the procedure
* History of bleeding diathesis
* ASA IV,
* Chronic gabapentin/pregabalin,opioid use
* Hepatic or renal insufficiency
* Previous operation on the same hip
* BMI \>40

Primary outcomes:
measure: Pain scores
timeFrame: Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours
measure: Opioid consumption
timeFrame: Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours
Secondary outcomes:
measure: Quadriceps muscle strength
timeFrame: Postoperative 24 hours period
measure: Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression
timeFrame: Postoperative 24 hours period
measure: Patient satisfaction
timeFrame: Postoperative 24 hours period
Other outcomes:
Locations:
city: Konya
country: Turkey
facility: Alper KILICASLAN
Study officials:
References:
citation: Hussain N, Brull R, Speer J, Hu LQ, Sawyer T, McCartney CJL, Abdallah FW. Analgesic benefits of the quadratus lumborum block in total hip arthroplasty: a systematic review and meta-analysis. Anaesthesia. 2022 Oct;77(10):1152-1162. doi: 10.1111/anae.15823. Epub 2022 Aug 10.
citation: Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.