Superiority Randomized Controlled Trial of Ultrasound-guided PENG Block Compared to Surgical Infiltration in the Analgesia of Posterior Total Hip Arthroplasty Surgery

NCT06257160 | Completed

• 1 other identifier: PO24003
• Study Type: interventional
• Target: 224
• Locations: 1 country
• Sites: 1

Brief Summary

Pain after total hip replacement (THR) surgery is severe. The target population is elderly and comorbid. Level III analgesics are responsible for significant side effects in this population. Locoregional analgesia, by reducing the consumption of painkillers, is an effective way of reducing morphine or morphine agonist consumption in this surgery. Furthermore, these techniques fit in perfectly with the objectives of accelerated rehabilitation after surgery. Surgical infiltration is a frequently used and effective analgesic technique. PENG block is a new locoregional anesthesia technique which initial results show promising analgesic efficacy and the absence of loss of strength through motor block. In February 2022, we carried out a survey of national anesthetic practices in posterior hip arthroplasty, with the help of the SFAR (Société Française d'Anesthésie-Réanimation). It shows that, despite the lack of plentiful literature on the subject, the PENG block is currently the most frequently performed pre-operative block in hip arthroplasty (PENG block in 39.5% of cases, femoral block in 13% of cases). The survey also shows that in 41.5% of cases, no block is performed, and only intraoperative surgical infiltration is carried out. PENG block and surgical infiltration are therefore the two analgesic techniques most frequently used in France today. It is for these reasons that we feel it is essential to carry out a study comparing these two techniques.

Conditions

Hip Arthropathy; Hip Arthrosis

Keywords

Analgesia; Hip; Arthroplasty; PENG; locoregional anesthesia; infiltration

Outcome Measures

Primary Outcomes (1)

• Morphine consumption

  At 24 hours postoperative

Secondary Outcomes (14)

• Pain evaluation

  At 1 hour postoperative

• Pain evaluation

  At 2 hours postoperative

• Pain evaluation

  At 6 hours postoperative

• Pain evaluation

  At 12 hours postoperative

• Pain evaluation

  At 24 hours postoperative

Study Arms (2)

Surgical infiltration

ACTIVE COMPARATOR

Procedure: Surgical infiltration

PENG Block ultrasound-guided

EXPERIMENTAL

Procedure: PENG Block ultrasound-guided

Interventions

Surgical infiltration PROCEDURE

During surgery, local anesthetics are injected as follow: in the deep plane and in the subcutaneous territory. Infiltration of the deep plane corresponds to pericotyloid injection, with particular attention to the posterior subcapsular area, the obturator foramen and the psoas muscle. Infiltration of the muscular planes is added, with infiltration of the gluteal and pelvitrochanteric muscles.

Surgical infiltration

PENG Block ultrasound-guided PROCEDURE

We perform the femoral block under ultrasound after anesthesia (general or rachianesthesia). The PENG block is a peripheral diffusion nerve block that specifically targets the articular divisions of the femoral, obturator and accessory obturator nerves. The femoral nerve innervates the four parts of the joint capsule, with inconsistency in the anterior inferomedial part of the capsule. The obturator nerve innervates the inferior part of the anterior face of the capsule. The accessory obturator nerve innervates the medial half of the hip joint capsule in over 50% of cases.

PENG Block ultrasound-guided

Eligibility Criteria

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

You may qualify if:

• Patients eligible for posterior total hip replacement surgery at Reims University Hospital
• Patients agreeing to take part in the research and having signed the informed consent form
• Patients of full age
• Patients affiliated to a social security scheme

You may not qualify if:

• Minor patients
• Patients protected by law
• Pregnant and breast-feeding women
• Patients with allergy to local anesthetics
• Patients with neuropathy
• Patients with an ASA score greater than or equal to 4
• Patients undergoing revision surgery on a total hip prosthesis
• Patients undergoing anterior total hip replacement surgery
• Patients suffering from a femur fracture
• Patients with a contraindication to Peng block.
• Patients refusing one of the proposed techniques.
• Persons deprived of their liberty by judicial or administrative decision.
• Persons under psychiatric care
• Persons unable to express their consent.

Sponsors & Collaborators

• CHU de Reims: lead

Study Sites (1)

Damien JOLLY

Reims, France

Location

MeSH Terms

Conditions

Osteoarthritis, Hip; Agnosia

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

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: SPONSOR

Study Record Dates

• First Submitted: February 6, 2024
• First Posted: February 13, 2024
• Study Start: May 22, 2024
• Primary Completion: September 18, 2025
• Study Completion: September 18, 2025
• Last Updated: December 3, 2025

Record last verified: 2025-11

Locations

FR (1)