QL vs PENG for Analgesia After Hip Arthroplasty

NCT05710107 | Completed Results DMC

• 1 other identifier: Pro00124880
• Study Type: interventional
• Target: 106
• Locations: 1 country
• Sites: 1

Brief Summary

This study will consist of patients 18 years and older who are undergoing elective hip replacement with planned same day discharge. The patients will be randomized to receive a PENG+LFC or QL block prior to undergoing the surgery to help with postoperative pain control. The primary goal will be assessing postoperative opioid use during the first 72 hours after surgery. Secondary outcomes will include postoperative pain scores from, 0-72 hours. Additional outcomes consist of time to first ambulation, functional and mobility outcomes, PACU duration, patient satisfaction and opioid related side effects.

Conditions

Block; Hip Replacement; Postoperative Pain

Outcome Measures

Primary Outcomes (1)

• Postoperative Cumulative Opioid Consumption

  The primary outcome will be postoperative cumulative opioid consumption (in IV morphine mg equivalents: IV MME) over time, from 0-72 hours postoperatively. Cumulative opioid consumption will be evaluated at PACU, and through 72 hours post-op.

  0-72 hours postoperatively

Secondary Outcomes (1)

• Average Postoperative Pain Score

  0-72 hours postoperatively

Other Outcomes (5)

• Time to First Ambulation

  From anesthesia stop time to first ambulation in minutes, assessed up to 7 days post-op.

• PROMIS Physical Health

  Up to 6 weeks post-operatively

• Overall Hip Health

  Up to 6 weeks post-operatively

Study Arms (2)

PENG + LFC Block

ACTIVE COMPARATOR

The pericapsular nerve group (PENG) block is an ultrasound-guided approach, first described by Giron-Arango et al. for the blockade of the articular branches of the femoral, obturator and accessory obturator nerves that provide sensory innervation to the anterior hip capsule \[5,6\]. In the PENG block, a low-frequency, curvilinear probe is used to visualize the anterior inferior iliac spine, iliopsoas tendon, and iliopubic eminence. After placing a subcutaneous skin wheel with lidocaine, a blunt regional anesthesia needle is inserted using in-plane ultrasound guidance. The needle is advanced until the tip lies on the lateral and inferior margin of the iliopsoas tendon between the anterior inferior iliac spine (lateral) and iliopubic eminence (deep).

Other: PENG + LFC Block

QL Block

ACTIVE COMPARATOR

The lateral QL block is performed by injecting local anesthetic deep to the transversus abdominis aponeurosis and superficial to the fascia transversalis with direct ultrasound guidance. After completing consent, placing monitors and providing mild sedation, the patient is positioned laterally and the muscular anatomy (external oblique, internal oblique, transverse abdominis, quadratus lumborum and latissimus dorsi muscles) identified. After placing a subcutaneous skin wheel with lidocaine, a blunt regional anesthesia needle is inserted using in-plane ultrasound guidance. Local anesthetic is deposited incrementally with frequent aspiration in the anterolateral border of the quadratus lumborum muscle at the junction of the transversalis fascia, outside the anterior layer of the thoracolumbar fascia and superficial to the fascia transversalis.

Other: QL Block

Interventions

PENG + LFC Block OTHER

Subjects assigned to this group will receive PENG + LFC Block

PENG + LFC Block

QL Block OTHER

Subjects randomized to this group will receive a QL Block

QL Block

Eligibility Criteria

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

You may qualify if:

• age greater than or equal to 18 years of age
• undergoing elective hip arthroplasty with planned same day discharge

You may not qualify if:

• local anesthetic allergy
• subjects with a weight less than 40kg
• subjects that are unable or choose not to give informed consent
• Known preoperative substance abuse

Sponsors & Collaborators

• Medical University of South Carolina: lead

Study Sites (1)

MUSC

Charleston, South Carolina, 29425, United States

Location

Related Publications (1)

• Hay E, Kelly T, Wolf BJ, Hansen E, Brown A, Lautenschlager C, Wilson SH. Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2024 Oct 10:rapm-2024-105875. doi: 10.1136/rapm-2024-105875. Online ahead of print.

  PMID: 39389587 DERIVED

MeSH Terms

Conditions

Bites and Stings; Pain, Postoperative

Condition Hierarchy (Ancestors)

Poisoning; Chemically-Induced Disorders; Wounds and Injuries; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Results Point of Contact

• Title: Ellen Johnson
• Organization: Medical University of South Carolina

hayell@musc.edu

843-792-2322

Study Officials

• Ellen Hay, MD

  Medical University of South Carolina

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Masking Details: Subjects, surgeons, and data collectors will all be blinded to the allocated group. Unblinded personnel will be the Anesthesia Attending placing the block and clinical staff assisting.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: January 12, 2023
• First Posted: February 2, 2023
• Study Start: February 7, 2023
• Primary Completion: November 12, 2023
• Study Completion: November 12, 2023
• Last Updated: December 20, 2024
• Results First Posted: December 20, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)