Comparison of Pericapsular Nerve Group Block and Quadratus Lumborum Block

NCT05654519 | Completed DMC

• 1 other identifier: 2021-541
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

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.

Conditions

Total Hip Surgery; Pericapsular Nerve; Quadratus Lumborum

Keywords

Total Hip Surgery; PENG block; QLB

Outcome Measures

Primary Outcomes (2)

• Pain scores

  Numerical Rating Scale-NRS (0 = no pain and 10 = worst imaginable painranged from 0 to 10)

  Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours

• Opioid consumption

  Mean opioid consumption in morphine equivalents

  Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours

Secondary Outcomes (3)

• Quadriceps muscle strength

  Postoperative 24 hours period

• Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression

  Postoperative 24 hours period

• Patient satisfaction

  Postoperative 24 hours period

Study Arms (2)

Group QL Block

ACTIVE COMPARATOR

A convex transducer will be placed in the transverse plane on the flank cranial to the iliac crest to visualise the transverse process of the 4th lumbar vertebra, erector spina, quadratus lumborum and psoas muscles as a 'Shamrock sign'. The needle will inserted in to the fascial plane between the quadratus lumborum and psoas muscles and 30 ml bupivacaine 0.25% will be administered.

Drug: PENG/LFCN and QL Blocks

Group PENG+LFCN Block

ACTIVE COMPARATOR

A linear probe will be placed on the anterior inferior iliac crest in the transverse plane while the patient is in the supine position. After rotating 45 degrees, the pubic ramus, femoral artery and psoas muscle will be visualized. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and the iliopubic eminence After a negative aspiration test, 25 ml bupivacaine 0.25% will be injected. Then, the lateral femoral cutaneous nerve (LFCN) block was performed using linear US probe (10-18 MHz).The LFCN will be localized, infero-medially to the antero-superior iliac spine, laterally to the sartorius muscle and 5 ml of bupivacaine 0.25% will be carefully injected.

Drug: PENG/LFCN and QL Blocks

Interventions

PENG/LFCN and QL Blocks DRUG

Bupivacaine 0.25% injection

Group PENG+LFCN Block; Group QL Block

Eligibility Criteria

• Age: 40 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

• 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

Sponsors & Collaborators

• Konya Necmettin Erbakan Üniversitesi: lead

Study Sites (1)

Alper KILICASLAN

Konya, Turkey (Türkiye)

Location

Related Publications (2)

• 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.

  PMID: 35947882 BACKGROUND

• 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.

  PMID: 30063657 BACKGROUND

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: The patient, and the outcomes assessor who performs postoperative pain evaluation will not know the group.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Professor

Model Details: Parallel Assignment

Study Record Dates

• First Submitted: November 30, 2022
• First Posted: December 16, 2022
• Study Start: January 1, 2022
• Primary Completion: April 10, 2023
• Study Completion: April 21, 2023
• Last Updated: December 20, 2024

Record last verified: 2023-04

Locations

TU (1)