PENG Block vs. Intraoperative Local Anesthetic Infiltration for Total Hip Arthroplasty

NCT05898581 | Recruiting

• 1 other identifier: PENG RCT
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Currently, the analgesic standard of care for patients undergoing total hip arthroplasty (THA) at our centre is intraoperative infiltration with a solution of local anesthetic, morphine (opioid), and ketorolac (nonsteroidal anti-inflammatory drug - NSAID). If a patient has a contraindication for the use of an opioid or NSAIDs, this infiltration is performed with a plain local anesthetic. No blocks (numbing of certain nerves to prevent pain from occurring in that area) are performed for postoperative pain in these patients. The pericapsular nerve group (PENG) block is a recently described technique with limited data in the literature that has assessed the benefits of using this nerve block for THA procedures. The purpose of this study is to investigate if the ultrasound-guided PENG block can provide non-inferior postoperative analgesia compared to local intraoperative anesthetic infiltration (ILAI) with an associated cost benefit for patients undergoing THA.

Conditions

Anesthesia

Keywords

anesthesia; total hip arthroplasty; Pericapsular Nerve Group Block

Outcome Measures

Primary Outcomes (1)

• PENG block impact on post-operative pain scores

  Patient pain scores will be evaluated at 8 hours and 24 hours following completion of spinal anesthesia to determine the impact of the PENG block on post-operative pain. Pain scores will be assessed using a Likert scale rating (0-10, 0 = no pain, 10 = sever, disabling pain).

  8-24 hours following completion of spinal anesthesia

Secondary Outcomes (3)

• PENG block impact on quadriceps muscle strength post-operatively

  8-24 hours following completion of spinal anesthesia

• Time spent in post-anesthesia care unit (PACU) following surgery

  Up to 24 hours following completion of spinal anesthesia.

• Patient opioid consumption 24 hours period after spinal anesthesia procedure.

  24 hours following following completion of spinal anesthesia.

Study Arms (2)

PENG Block

EXPERIMENTAL

Participants will receive ultrasound-guided PENG block (PENG group) with local anesthetics (20 ml of 0.5% ropivacaine) before administration of spinal anesthesia. Patients in this group will also receive a sham ILAI procedure with 60 mL of saline (performed by the operating surgeon).

Procedure: PENG Block

Control Group

SHAM COMPARATOR

Participants will receive a sham PENG block performed with 20ml of normal saline solution before spinal anesthesia. After, patients will receive ILAI (performed by the operating surgeon) with a plain solution of ropivacaine 0.25% 60ml.

Procedure: Control Group

Interventions

PENG Block PROCEDURE

Participants will receive a PENG block with local anesthetics (which is a freezing medication, in this case, 0.5% ropivacaine) before receiving spinal anesthesia. Patients in this group will also receive a sham ILAI procedure with 60 mL of saline (performed by the operating surgeon).

PENG Block

Control Group PROCEDURE

Participants will receive a sham PENG block performed with 20ml of normal saline solution before spinal anesthesia. After, patients will receive ILAI (performed by the operating surgeon) with a plain solution of ropivacaine 0.25% 60ml.

Control Group

Eligibility Criteria

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

You may qualify if:

• Adult patient (\>18 years old)
• Undergoing THA with a direct lateral surgical approach (transgluteal approach)
• Ability to provide verbal/written consent to participate in this trial

You may not qualify if:

• Patient with any contraindication for spinal anesthesia
• Patient with any contraindication for regional analgesia
• Patient undergoing THA with a direct anterior surgical approach
• Patients undergoing THA for hip revision
• Patients undergoing THA under One Day Stay (ODS) admission
• Patients that received opioids intrathecally
• Patients having residual motor block six hours after the completion of the spinal anesthesia.
• Patients with a history of regular opioid intake for more than three months
• Patients incapable of performing knee extension of the same operative side
• Pregnant patients

Sponsors & Collaborators

• London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's: lead

Study Sites (1)

London Health Sciences Centre

London, Ontario, Canada

RECRUITING

Related Publications (19)

• Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, Aleshi P. Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial. Anesthesiology. 2018 Sep;129(3):536-543. doi: 10.1097/ALN.0000000000002321.

  PMID: 29975203 BACKGROUND

• Xing JG, Abdallah FW, Brull R, Oldfield S, Dold A, Murnaghan ML, Whelan DB. Preoperative Femoral Nerve Block for Hip Arthroscopy: A Randomized, Triple-Masked Controlled Trial. Am J Sports Med. 2015 Nov;43(11):2680-7. doi: 10.1177/0363546515602468. Epub 2015 Sep 24.

  PMID: 26403206 BACKGROUND

• Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018 Feb;43(2):186-192. doi: 10.1097/AAP.0000000000000701.

  PMID: 29140962 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

• Ban WR, Zhang EA, Lv LF, Dang XQ, Zhang C. Effects of periarticular injection on analgesic effects and NSAID use in total knee arthroplasty and total hip arthroplasty. Clinics (Sao Paulo). 2017 Dec;72(12):729-736. doi: 10.6061/clinics/2017(12)03.

  PMID: 29319718 BACKGROUND

• Villatte G, Engels E, Erivan R, Mulliez A, Caumon N, Boisgard S, Descamps S. Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study. Int Orthop. 2016 Nov;40(11):2255-2260. doi: 10.1007/s00264-016-3133-3. Epub 2016 Feb 22.

  PMID: 26899484 BACKGROUND

• Murphy TP, Byrne DP, Curtin P, Baker JF, Mulhall KJ. Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty? Clin Orthop Relat Res. 2012 Apr;470(4):1151-7. doi: 10.1007/s11999-011-2108-3. Epub 2011 Sep 30.

  PMID: 21960156 BACKGROUND

• Liu W, Cong R, Li X, Wu Y, Wu H. Reduced opioid consumption and improved early rehabilitation with local and intraarticular cocktail analgesic injection in total hip arthroplasty: a randomized controlled clinical trial. Pain Med. 2011 Mar;12(3):387-93. doi: 10.1111/j.1526-4637.2010.01043.x. Epub 2011 Jan 25.

  PMID: 21266004 BACKGROUND

• Busch CA, Whitehouse MR, Shore BJ, MacDonald SJ, McCalden RW, Bourne RB. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty. Clin Orthop Relat Res. 2010 Aug;468(8):2152-9. doi: 10.1007/s11999-009-1198-7. Epub 2009 Dec 18.

  PMID: 20020333 BACKGROUND

• Hofstad JK, Winther SB, Rian T, Foss OA, Husby OS, Wik TS. Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty. Acta Orthop. 2015;86(6):654-8. doi: 10.3109/17453674.2015.1053775. Epub 2015 May 22.

  PMID: 25997827 BACKGROUND

• den Hartog YM, Mathijssen NM, van Dasselaar NT, Langendijk PN, Vehmeijer SB. No effect of the infiltration of local anaesthetic for total hip arthroplasty using an anterior approach: a randomised placebo controlled trial. Bone Joint J. 2015 Jun;97-B(6):734-40. doi: 10.1302/0301-620X.97B6.35343.

  PMID: 26033051 BACKGROUND

• Zoric L, Cuvillon P, Alonso S, Demattei C, Vialles N, Asencio G, Ripart J, Nouvellon E. Single-shot intraoperative local anaesthetic infiltration does not reduce morphine consumption after total hip arthroplasty: a double-blinded placebo-controlled randomized study. Br J Anaesth. 2014 Apr;112(4):722-8. doi: 10.1093/bja/aet439. Epub 2014 Jan 14.

  PMID: 24431385 BACKGROUND

• Lunn TH, Husted H, Solgaard S, Kristensen BB, Otte KS, Kjersgaard AG, Gaarn-Larsen L, Kehlet H. Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2011 Sep-Oct;36(5):424-9. doi: 10.1097/AAP.0b013e3182186866.

  PMID: 21610559 BACKGROUND

• Hirasawa N, Kurosaka K, Nishino M, Nakayama T, Matsubara M, Tsukada S. No Clinically Important Difference in Pain Scores After THA Between Periarticular Analgesic Injection and Placebo: A Randomized Trial. Clin Orthop Relat Res. 2018 Sep;476(9):1837-1845. doi: 10.1097/CORR.0000000000000374.

  PMID: 29939894 BACKGROUND

• Dobie I, Bennett D, Spence DJ, Murray JM, Beverland DE. Periarticular local anesthesia does not improve pain or mobility after THA. Clin Orthop Relat Res. 2012 Jul;470(7):1958-65. doi: 10.1007/s11999-012-2241-7. Epub 2012 Jan 24.

  PMID: 22270468 BACKGROUND

• Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. A Retrospective Case Series of Pericapsular Nerve Group (PENG) Block for Primary Versus Revision Total Hip Arthroplasty Analgesia. Cureus. 2020 May 19;12(5):e8200. doi: 10.7759/cureus.8200.

  PMID: 32572357 BACKGROUND

• Aliste J, Layera S, Bravo D, Jara A, Munoz G, Barrientos C, Wulf R, Branez J, Finlayson RJ, Tran Q. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med. 2021 Oct;46(10):874-878. doi: 10.1136/rapm-2021-102997. Epub 2021 Jul 20.

  PMID: 34290085 BACKGROUND

• Lin DY, Brown B, Morrison C, Fraser NS, Chooi CSL, Cehic MG, McLeod DH, Henningsen MD, Sladojevic N, Kroon HM, Jaarsma RL. The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial. BMC Anesthesiol. 2022 Aug 6;22(1):252. doi: 10.1186/s12871-022-01787-2.

  PMID: 35933328 BACKGROUND

• Zheng J, Pan D, Zheng B, Ruan X. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Reg Anesth Pain Med. 2022 Mar;47(3):155-160. doi: 10.1136/rapm-2021-103228. Epub 2021 Dec 6.

  PMID: 34873023 BACKGROUND

Related Links

• Joint replacement at LHSC

MeSH Terms

Interventions

Control Groups

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Shalini Dhir, FRCPC

  Western University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Shalini Dhir, FRCPC

CONTACT

519-685-8500; shalini.dhir@sjhc.london.on.ca

Rodrigo Araujo Monteiro da Silva, MD

CONTACT

519-685-8500; rodrigo.araujomonteirodasilva@lhsc.on.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiologist, Associate Professor

Model Details: The study will be a single-centre, double-blinded non-inferiority randomized controlled trial.

Study Record Dates

• First Submitted: June 2, 2023
• First Posted: June 12, 2023
• Study Start: November 1, 2024
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: September 18, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)