Comparison of Pericapsular Nerve Group (PENG) Block With a Combined Femoral, Sciatic, Lateral Femoral Cutaneous Nerve Block for Postoperative Analgesia in Secondary Total Hip Arthroplasty; (REVPET)

NCT07109388 | Not Yet Recruiting DMC

• 1 other identifier: 2025-00488
• Study Type: interventional
• Target: 50
• Locations: 0 countries
• Sites: N/A

Brief Summary

The aim of this clinical trial is to compare the analgesic effect of a pericapsular nerve group (PENG) block with a combined femoral, sciatic, lateral femoral cutaneous nerve block for postoperative analgesia in patients scheduled for secondary total hip arthroplasty. The primary objective of this study is to compare postoperative pain management between the PENG block and the combined block (femoral, sciatic, lateral femoral cutaneous) by measuring postoperative morphine consumption in each of the two groups. Participants will be randomized into two groups. Patients assigned to the PENG group will receive a PENG block with ropivacaine, followed by a sham (sciatic) block, and spinal anesthesia with isobaric bupivacaine. Patients assigned to the combined block group will receive femoral, sciatic, lateral femoral cutaneous nerve blocks with ropivacaine, followed by spinal anesthesia with isobaric bupivacaine.

Conditions

Hip Arthroplasty Replacement; Post Operative Analgesia; Post Operative Pain, Acute

Keywords

nerve block; postoperative pain; hip arthroplasty replacement

Outcome Measures

Primary Outcomes (1)

• Cumulative postoperative morphine consumption at day 1

  Description: total consumption in mg

  Time Frame: 24 hours postoperatively

Secondary Outcomes (9)

• Morphine consumption in the recovery room

  from admission till discharge from the recovery room, up to 2 hours

• PCA administered morphine consumption at day 2

  at day 2 postoperatively

• Rest and dynamic pain scores

  At 2 hours, day 1 and day 2 postoperatively

• Incidence of postoperative nausea and vomiting

  at 2 hours, day 1 and day 2 postoperatively

• Incidence of pruritus

  at 2 hours, day 1 and day 2 postoperatively

Study Arms (2)

PENG group

EXPERIMENTAL

Pericapsular nerve group block

Drug: Pericapsular nerve group (PENG) block with 0.75% ropivacaine guided by ultrasound

Combined nerve block

ACTIVE COMPARATOR

Combined femoral, sciatic, lateral femoral cutaneous nerve block

Drug: Femoral, sciatic and lateral femoral cutaneous nerve block with 0.375% ropivacaine

Interventions

Pericapsular nerve group (PENG) block with 0.75% ropivacaine guided by ultrasound DRUG

Participants in the PENG group will first receive a sham sciatic injection; the needle will be inserted into the subcutaneous tissue and 3 ml of 0.9% NaCl will be injected. They will then receive a PENG nerve block in the supine position. A low-frequency (2-5 MHz) curvilinear ultrasound probe (BK Ultrasound) will be used to identify the anterior inferior iliac spine, the pubic eminence, and the psoas tendon with its fascial plane. A 22-gauge, 50 mm needle (SonoPlex® Pajunk) will be inserted into the fascial plane to inject 20 ml of 0.75% ropivacaine (Fresenius Kabi).

Also known as: PENG block

PENG group

Femoral, sciatic and lateral femoral cutaneous nerve block with 0.375% ropivacaine DRUG

Participants in the combined group will first receive a sciatic nerve block performed with the patient in a semi-prone position, the lower limb flexed at 90° (hip and knee), elevated with a cushion placed between the legs. A straight line will be drawn between the greater trochanter and the ischial tuberosity. The sciatic nerve is located approximately at the midpoint of this line. Under ultrasound guidance, the ischial tuberosity will be identified medially, the greater trochanter laterally, the gluteus maximus muscle superficially beneath the adipose tissue, and the quadratus femoris muscle in depth. A 22-gauge, 50 mm needle will then be inserted into the fascial plane to inject 20 ml of 0.375% ropivacaine. The patient is then placed supine for femoral and lateral femoral cutaneous nerve blocks. 15 ml of local anaesthetics will be injected around the femoral nerve and 5 around the lateral femoral cutaneous nerve.

Combined nerve block

Eligibility Criteria

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

You may qualify if:

• Male and female patients
• ASA (American Society of Anaesthesiologists) I-III
• years of age or older
• Patients scheduled for elective secundary hip arthroplasty
• Able to give written conformed consent autonomously

You may not qualify if:

• Refusal or inability to give consent
• Allergy to any of: ropivacaine, paracetamol, ibuprofen, ketorolac, morphine, ondansetron or dexamethasone
• Bleeding diathesis
• Neurological deficit of the operative side
• Existing preoperative opioid use
• Renal insufficiency (GFR\<30ml/min according to the Cockroft-Gault formula)
• Hepatic insufficiency
• Morbid Obésity III

Sponsors & Collaborators

• Centre Hospitalier Universitaire Vaudois: lead

Related Publications (6)

• She C, Liu H. The efficacy of pericapsular nerve group block for reducing pain and opioid consumption after total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2024 Apr 8;19(1):229. doi: 10.1186/s13018-024-04707-x.

  PMID: 38584259 BACKGROUND

• Newman JT, Briggs KK, McNamara SC, Philippon MJ. Outcomes After Revision Hip Arthroscopic Surgery in Adolescent Patients Compared With a Matched Cohort Undergoing Primary Arthroscopic Surgery. Am J Sports Med. 2016 Dec;44(12):3063-3069. doi: 10.1177/0363546516659656. Epub 2016 Aug 11.

  PMID: 27514736 BACKGROUND

• Bohl DD, Samuel AM, Basques BA, Della Valle CJ, Levine BR, Grauer JN. How Much Do Adverse Event Rates Differ Between Primary and Revision Total Joint Arthroplasty? J Arthroplasty. 2016 Mar;31(3):596-602. doi: 10.1016/j.arth.2015.09.033. Epub 2015 Sep 28.

  PMID: 26507527 BACKGROUND

• Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003 Jan;85(1):27-32. doi: 10.2106/00004623-200301000-00005.

  PMID: 12533568 BACKGROUND

• Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5. doi: 10.2106/JBJS.F.00222.

  PMID: 17403800 BACKGROUND

• Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030. J Arthroplasty. 2020 Jun;35(6S):S79-S85. doi: 10.1016/j.arth.2020.02.030. Epub 2020 Feb 19.

  PMID: 32151524 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Dental Occlusion; Ropivacaine

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Central Study Contacts

Eric Albrecht, Prof

CONTACT

+41795566341; eric.albrecht@chuv.ch

Melissa Wüst

CONTACT

+41795569991; melissa.wust@chuv.ch

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Prof. Dr. Med. Eric Albrecht, Associate Professor, University of Lausanne

Model Details: This is a single-center, prospective, superiority, randomized, double-blind, parallel-group study.

Study Record Dates

• First Submitted: July 7, 2025
• First Posted: August 7, 2025
• Study Start: September 30, 2025
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): September 1, 2027
• Last Updated: September 22, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share