PENG vs L-ESPB With S-ESPB for Analgesia in Total Hip Arthroplasty

NCT07180979 | Not Yet Recruiting Phase 4

• 1 other identifier: 03/2025
• Study Type: interventional
• Target: 90
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this clinical trial is to evaluate whether different types of regional anesthesia can improve pain control and functional recovery after total hip arthroplasty in adult patients undergoing elective hip replacement surgery. The main questions it aims to answer are: Does the PENG block reduce opioid use in the first 48 hours after surgery more effectively than the combined L-ESPB + S-ESPB technique? Which method provides better pain relief, preserves muscle strength, and supports earlier mobilization? Researchers will compare the Pericapsular Nerve Group (PENG) block with the combination of Lumbar and Sacral Erector Spinae Plane Blocks (L-ESPB + S-ESPB) to see which provides better pain control, fewer side effects, and faster recovery. Participants will: Be randomly assigned to receive one of the two types of ultrasound-guided regional anesthesia Undergo standard hip replacement surgery under spinal anesthesia Be monitored for pain scores, opioid use, time to first walking, muscle strength, satisfaction, and side effects over the first 48 hours after surgery.

Conditions

Hip Osteoarthritis; Hip Arthropathy; Hip Pain Chronic

Outcome Measures

Primary Outcomes (1)

• Total opioid consumption

  morphine milligram equivalents (MME)

  first 48 hours postoperatively

Secondary Outcomes (11)

• Pain scores

  4 hours after surgery

• Pain scores

  8 hours after surgery

• Pain scores

  12 hours after surgery

• Pain scores

  24 hours after surgery

• Pain scores

  48 hours after surgery

Study Arms (3)

Control group

PLACEBO COMPARATOR

All participants will receive standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia according to institutional protocol.

Drug: Ropivacaine 0.5% Injectable Solution

PENG + LFCN

ACTIVE COMPARATOR

Participants in this group will receive an ultrasound-guided pericapsular nerve group (PENG) block combined with a lateral femoral cutaneous nerve (LFCN) block using local anesthetic. To preserve blinding, sham procedures will be performed at the lumbar and sacral erector spinae plane block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be administered as per institutional protocol.

Drug: Ropivacaine 0.2% Injectable Solution

L-ESPB + S-ESPB

ACTIVE COMPARATOR

Participants in this group will receive ultrasound-guided lumbar erector spinae plane block (L-ESPB) combined with sacral erector spinae plane block (S-ESPB) using local anesthetic. To preserve blinding, sham procedures will be performed at the pericapsular and lateral femoral cutaneous nerve block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be provided according to institutional protocol.

Drug: Ropivacaine 0.2% Injectable Solution

Interventions

Ropivacaine 0.5% Injectable Solution DRUG

All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.

Also known as: Spinal Anesthesia

Control group

Ropivacaine 0.2% Injectable Solution DRUG

Ultrasound-guided pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block, with sham lumbar and sacral ESPBs. PENG block: 20 mL of 0.2% ropivacaine. LFCN block: 5 mL of 0.2% ropivacaine. Sham lumbar ESPB: 1-2 mL preservative-free normal saline at lumbar ESPB site. Sham sacral ESPB: 1-2 mL preservative-free normal saline at sacral ESPB site. All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.

PENG + LFCN

Eligibility Criteria

• Age: 65 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Age ≥ 65 years
• ASA physical status I-III
• Elective unilateral THA via posterior or lateral approach
• Informed consent provided

You may not qualify if:

• Allergy to study drugs (ropivacaine, dexamethasone)
• Chronic opioid use (\>30 MME/day)
• Coagulopathy or infection at the injection site
• BMI \> 40 kg/m²
• Pre-existing motor weakness or neuropathy in the affected limb
• Cognitive impairment precluding informed consent

Sponsors & Collaborators

• Poznan University of Medical Sciences: lead

MeSH Terms

Conditions

Osteoarthritis, Hip

Interventions

Ropivacaine; Anesthesia, Spinal

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia

Study Officials

• Malgorzata Reysner

  Poznan University of Medical Sciences

  STUDY CHAIR

• Tomasz Reysenr, M.D.

  Poznan Univesity of Medical Sciences

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Malgorzata Reysner, M.D. Ph.D.

CONTACT

+48 61 873 83 03; mreysner@ump.edu.pl

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

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

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will share