PENG vs PHPB for Hip Arthroplasty Analgesia

NCT07263932 | Active Not Recruiting

• 1 other identifier: E2-25-12993
• Study Type: observational
• Target: 127
• Locations: 1 country
• Sites: 1

Brief Summary

Total hip arthroplasty (THA) is a commonly performed surgical procedure, and its incidence continues to rise with the aging population. Effective postoperative analgesia facilitates early mobilization and accelerates recovery. The pericapsular nerve group (PENG) block provides analgesia to the anterior hip capsule by targeting the articular branches of the femoral, obturator, and accessory obturator nerves. However, due to the contribution of sacral plexus-derived nerves (quadratus femoris, superior gluteal, and inferior gluteal nerves) to posterior hip pain, anterior blocks alone may be insufficient. This prospective study aims to compare the efficacy of preoperatively administered PENG block alone versus the combination of PENG and posterior hip pericapsular block (PHPB) in postoperative pain control after total hip arthroplasty. The primary outcome is postoperative pain intensity assessed by the Numerical Rating Scale (NRS). Secondary outcomes include the Quality of Recovery score (QoR-15), opioid consumption, manual muscle testing (MMT) results, time to mobilization, and block-related complications.

Conditions

PENG Block; Hip Arthroplasty, Total; QoR-15; Numeric Rating Scale

Outcome Measures

Primary Outcomes (1)

• Postoperative pain

  Postoperative pain will be assessed using the Numeric Rating Scale (NRS; 0 = no pain, 10 = worst imaginable pain) at rest and during movement at 0, 2, 6, 8, 12, 24, 36, and 48 hours after surgery. The NRS scores will be compared between the two study groups (PENG vs. PENG + PHPB) to evaluate the effectiveness of the blocks in postoperative analgesia following total hip arthroplasty.

  Up to 48 hours postoperatively

Secondary Outcomes (5)

• QUALİTY OF RECOVERY-15

  Preoperative, 24, and 48 hours postoperatively

• MANUEL MUSCLE TEST

  6, 12, and 24 hours postoperatively

• Rescue analgesic

  0-48 hours postoperatively

• Postoperative Nausea and Vomiting (PONV)

  0-48 hours postoperatively

• Length of Hospital Stay

  Up to discharge (approximately 3-5 days postoperatively)

Study Arms (2)

PENG Group

The group that will receive the preoperative Pericapsular Nerve Group (PENG) block

Procedure: PENG Block

PENG + PHPB Group

The group that will receive the preoperative Pericapsular Nerve Group (PENG) block and Posterior Hip Pericapsular Block (PHPB)

Procedure: PENG Block and Posterior Hip Pericapsular Block

Interventions

PENG Block and Posterior Hip Pericapsular Block PROCEDURE

Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule. In addition to the PENG block, a Posterior Hip Pericapsular Block (PHPB) will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The local anesthetic will be injected between the piriformis muscle and the ischiofemoral ligament to target the posterior articular branches of the quadratus femoris, superior gluteal, and inferior gluteal nerves. The combined PENG + PHPB approach aims to provide comprehensive analgesia of both the anterior and posterior hip capsule while preserving motor function.

PENG + PHPB Group

PENG Block PROCEDURE

Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule.

PENG Group

Eligibility Criteria

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

Study Population

Adult patients aged 18 years and older, classified as ASA physical status I-II, scheduled for elective total hip arthroplasty under spinal anesthesia at Ankara Bilkent City Hospital. A total of 132 patients who meet the inclusion criteria and provide written informed consent will be enrolled in this single-center, prospective, randomized controlled trial.

You may qualify if:

• Patients scheduled for elective total hip arthroplasty (THA) under spinal anesthesia
• ASA physical status I-II
• Age ≥18 years
• Body Mass Index (BMI) between 18-35 kg/m²
• Patients who provide written informed consent

You may not qualify if:

• Age \<18 years
• ASA physical status ≥III
• Known allergy or contraindication to study medications (local anesthetics, opioids, etc.)
• Severe cardiac, renal, hepatic, or pulmonary failure
• Revision total hip arthroplasty
• Coagulopathy or anticoagulant use
• Local infection or neuropathic findings at the injection site
• Chronic inflammatory diseases or chronic corticosteroid use
• Diagnosed neuropsychiatric disorders
• Pregnancy or lactation
• Inability or unwillingness to read, understand, or sign the informed consent form
• Obesity (BMI \>35 kg/m²)
• Failed spinal anesthesia or conversion to general anesthesia
• Active malignancy or patients receiving radiotherapy/chemotherapy
• Active systemic infection or ongoing antibiotic therapy (except prophylaxis)

Sponsors & Collaborators

• Ankara City Hospital Bilkent: lead

Study Sites (1)

Ankara Bilkent City Hospital Departmant of Anesthesiology and Reanimation, Ankara,Çankaya

Ankara, Çankaya, 06800, Turkey (Türkiye)

Location

Related Publications (3)

• Atalay YO, Ciftci B, Tekin B, Ansen G, Sakul BU, Cacan MA, Azboy I, Yilmaz B, Alici HA. A Case Series of Deep Subgluteal Block: A New Block Targeting the Missed Portion of the Hip for Analgesia After Total Hip Replacement. A A Pract. 2024 Sep 9;18(9):e01848. doi: 10.1213/XAA.0000000000001848. eCollection 2024 Sep 1.

  PMID: 39250338 RESULT

• Duan L, Li J, Chen Z, Wen T, He J, Zhang A. Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series. BMC Anesthesiol. 2024 Oct 1;24(1):352. doi: 10.1186/s12871-024-02731-2.

  PMID: 39354374 RESULT

• Vermeylen K, Van Aken D, Versyck B, Casaer S, Bleys R, Bracke P, Groen G. Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study. BJA Open. 2023 Feb 15;5:100127. doi: 10.1016/j.bjao.2023.100127. eCollection 2023 Mar.

  PMID: 37587997 RESULT

Study Officials

• Abdulkadir But, Professor

  Ankara Bilkent City Hospital Departmant of Anesthesiology and Reanimation,Ankara,Çankaya

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Target Duration: 2 Days
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 24, 2025
• First Posted: December 4, 2025
• Study Start: December 1, 2025
• Primary Completion: April 15, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: May 6, 2026

Record last verified: 2025-10

Locations

TU (1)