Sacral ESPB vs. PENG Block for Hip Hemiarthroplasty Analgesia

NCT07442721 | Recruiting

• 1 other identifier: D 447
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Sacral erector spinae plane block(S-ESPB) has been recently described. Case reports are showing that it is useful in various types of surgery. In case presentations, it has been reported as effective in providing analgesia in the posterior branches of the sacral nerves in pilonidal sinus surgery, in the treatment of radicular pain at the L5 - S1 level, after a sex reassignment operation and hypospadias surgery, and its use in combination with lumbar ESPB for analgesia was reported after hip prosthesis surgery . Described in 2018, pericapsular nerve group (PENG) block selectively targets the articular branches of the femoral and accessory obturator nerves thereby providing potential motorsparing analgesia for hip surgery . Recent studies found that PENG block targets the articular branches of the femoral and accessory obturator nerves, only anesthetizes the anterior hip joint sparing posterior part , as well as there was a motor impairment after block which is from local anesthetic (LA) diffusion to the femoral nerve . Motor-sparing regional anesthesia techniques have emerged as a safer alternative, balancing effective pain relief with the preservation of quadriceps function . These techniques align with Enhanced Recovery After Surgery (ERAS) protocols, which emphasize multimodal pain control, opioid minimization, and early mobility to reduce complications such as venous thromboembolism (VTE) and postoperative pneumonia .

Conditions

Hip Arthroplasty; Hip Fracture Surgeries; Femoral Neck Fractures; Postoperative Pain

Outcome Measures

Primary Outcomes (1)

• Numerical pain rating score (NPRS) after surgery at rest.

  Numerical Pain Rating Scale (NPRS) is a subjective measure where patients rate their pain on an 11-point numerical scale. The scale ranges from 0 to 10, where 0 represents "no pain" and 10 represents "worst possible pain." Higher scores indicate a worse outcome (greater pain intensity).

  At twelve hours postoperatively

Secondary Outcomes (10)

• Numerical Pain Rating Scale(NPRS) during movement and at rest in 24 h after surgery at (2,4,6,8,12,18,24)

  At 2, 4, 6, 8, 12, 18, and 24 hours postoperatively.

• Cumulative morphine consumption in 24 hours in mg

  During the first 24 hours postoperatively

• Time for first rescue analgesia (hours), standard rescue analgesia (Morphine PCA or IV (dose specified)

  In the first 24 hours postoperatively

• Intraoperative opioids consumption.

  Intraoperative peroid

• Inability to perform physiotherapy at 24 hours.

  At 24 hours postoperatively.

Study Arms (2)

S group

ACTIVE COMPARATOR

This group will receive sacral erector spinae plane block in the operating room, after spinal anesthesia and before skin incision, when the patient will be in the lateral decubitus position, aseptic conditions will be provided for the block.

Procedure: Sacral erector spinae plane block

G group

ACTIVE COMPARATOR

This group will receive PENG Block in the operating room, after spinal anesthesia and before skin incision. Patients will be placed in the supine position, aseptic conditions will be provided for the block.

Procedure: PENG block

Interventions

Sacral erector spinae plane block PROCEDURE

the curvilinear transducer of ultrasound will be placed parallel to the median sacral crest pointing towards the caudal direction. After visualizing the S1 median sacral crest, the transducer will be shifted caudally. When the S2 level will be reached, the transducer will be moved 3-4 cm laterally. Then, the intermediate crest (IC) will be detected in the parasagittal plane. At the S2-3 level, a 22-gauge Quincke spinal needle,90 mm in length will be advanced in the caudo-cranial direction under the erector spinae muscle but superficial to the transverse process at the sacral level and achieving bone contact (at depth from 3cm to 5cm according to subcutaneous tissue thickness and muscle mass). Then local anesthetic (LA)(0.5mL/kg of bupivacaine 0.25%) will be injected following negative aspiration ensuring that total administered dose remains below toxicity threshold(150mg). The correct spread is confirmed by visualizing LA separating the erector spinae muscle from the underlying bone.

S group

PENG block PROCEDURE

The ultrasound transducer will be placed in a transverse orientation, medial and caudal to the anterosuperior iliac spine in order to identify the anteroinferior iliac spine, the iliopubic eminence and the psoas tendon. Using an in-plane technique and a lateral-to-medial direction, a 22-gauge Quincke spinal needle,90 mm in length will be advanced until its tip will be positioned on the periosteum dorsal to the psoas tendon (3-5cm from the skin). The local anesthetic (0.5mL/kg of bupivacaine 0.25%) will be injected following negative aspiration ensuring that total administered dose remains below toxicity threshold(150mg). The accurate position of the needle will be confirmed by hydro dissection and spread under the ilio-psoas muscle. To avoid femoral nerve involvement, and therefore quadriceps weakness ,the investigator will perform lateral needle placement (away from the undersurface of the iliopsoas tendon), also lower volume is needed, slower injection.

G group

Eligibility Criteria

• Age: 50 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients with ages from 50 to 90 years of either gender, with diagnosis of intracapsular neck of femur fracture scheduled for elective hip hemiarthroplasty • Patients with an American Society of Anesthesiologists (ASA) physical status I to III.

You may not qualify if:

• Patient refusal.
• Allergy to local anesthetics and patient with infection at the injection site of block
• Patient with contraindication to spinal anesthesia.
• Coagulopathy as INR≥1.5 or platelets ≤80\*103 / microliter)
• Patients with body mass index\>35 kg / m2
• Patients with peripheral neuropathy or diabetic neuropathy
• Patients receiving opioids for chronic analgesic therapy (cancer, addiction).
• Cognitive impairment preventing pain scoring.
• Chronic renal failure requiring dose modification.
• Bilateral hip fracture or previous ipsilateral hip surgery

Sponsors & Collaborators

• Fayoum University Hospital: lead

Study Sites (1)

Fayoum University hospita

El Fayoum Qesm, Faiyum Governorate, 63514, Egypt

RECRUITING

Related Publications (19)

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MeSH Terms

Conditions

Femoral Neck Fractures; Pain, Postoperative

Condition Hierarchy (Ancestors)

Hip Fractures; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

Samar Ahmed Ramadan

CONTACT

01028384348; sar15@fayoum.edu.eg

Mohamed Ahmed Hamed

CONTACT

01010509736; mah07@fayoum.edu.eg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: professor of anesthesia, Surgical ICU and Pain management , Faculty of Medicine, Fayoum University

Study Record Dates

• First Submitted: February 19, 2026
• First Posted: March 2, 2026
• Study Start: February 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): August 1, 2027
• Last Updated: March 3, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)