Pericapsular Nerve Group (PENG) Block Versus Periarticular Injection for Pain Management After Total Hip Arthroplasty

NCT04981236 | Completed DMC

• 1 other identifier: 4-2021-0725
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief Summary

Adequate pain control after total hip arthroplasty is crucial for early ambulation and patient satisfaction. The pericapsular nerve group (PENG) block has been recently introduced a new technique for blockade of the articular branches of the femoral, obturator and accessory obturator nerves. PENG block provides sufficient analgesia but it is still the potential for quadriceps weakness that might delay ambulation. Periarticular injection has attached attention as an effective analgesic modality with a low prevalence of adverse effects. The investigators will compare ultrasound-guided PENG block with periarticular injection in patients undergoing total hip arthroplasty.

Conditions

Total Hip Arthroplasty; Postoperative Pain

Outcome Measures

Primary Outcomes (1)

• Numeric rating scale pain score

  Pain intensity at rest evaluated by an 11-point numeric rating scale (NRS: 0 = no pain, 10 = worst imaginable pain) at 24 hours postoperatively

  at 24 hours postoperatively

Secondary Outcomes (2)

• Numeric rating scale pain score

  at 6 hours postoperatively and 48h postoperatively

• Quadriceps muscle strength

  at 24 hours postoperatively

Study Arms (2)

Pericapsular nerve group block

ACTIVE COMPARATOR

Participants receiving pericapsular nerve group block

Procedure: Pericapsular nerve group block

Periarticular block

EXPERIMENTAL

Participants receiving periarticular block

Procedure: Periarticular block

Interventions

Pericapsular nerve group block PROCEDURE

A curvilinear 2-5MHz ultrasound probe will be initially placed in a transverse plane over the anterior superior iliac spine and then aligned with the pubic ramus by rotating the probe counterclockwise approximately 45 degrees. In this view, the iliopubic eminence, the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle will be observed. A 22-gauge, 80-mm needle will be inserted from lateral to medial in an in-plane approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. A total volume of 20 ml of ropivacaine 0.3% will be injected.

Also known as: PENG block

Pericapsular nerve group block

Periarticular block PROCEDURE

The periarticular injection solution contained 20mL of 7.5 mg/mL ropivacaine, 30mg of ketorolac, and 0.3mL of 1.0 mg/mL epinephrine. These agents were mixed with normal saline to a combined volume of 50mL. The surgeon injected this mixture into the tensor fascia lata, subcutaneous tissues, abductors, short external rotators muscles, and structures in the capsule.

Periarticular block

Eligibility Criteria

• Age: 19 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 19 years old or older
• American Society of Anesthesiologists Physical Status 1-3
• Scheduled for elective unilateral total hip arthroplasty

You may not qualify if:

• Allergy or intolerance to any of the drugs used in the study
• Hepatic or renal insufficiency
• Opioid dependency
• Coagulopathy
• Pre-existing neurologic or anatomic deficits in the lower extremities
• Severe psychiatric illness

Sponsors & Collaborators

• Yonsei University: lead

Study Sites (1)

Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Seoul, South Korea

Location

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• Yong Seon Choi

  Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 22, 2021
• First Posted: July 28, 2021
• Study Start: August 17, 2021
• Primary Completion: May 26, 2023
• Study Completion: May 26, 2023
• Last Updated: February 15, 2024

Record last verified: 2024-02

Data Sharing

• IPD Sharing: Will not share

Locations

KR (1)