Pericapsular Nerve Group Block Versus Intrathecal Morphine for Pain After Hip Surgery

NCT07784192 | Recruiting

• 1 other identifier: SU-ANES-2025-711
• Study Type: interventional
• Target: 64
• Locations: 1 country
• Sites: 1

Brief Summary

Pain after hip replacement surgery is often severe and is commonly treated with opioids, which may cause nausea, vomiting, sedation, difficulty passing urine and slow breathing. This study will compare two ways of controlling pain in adults having hip surgery under spinal anesthesia. One group will receive morphine added to the spinal injection. The other group will receive an ultrasound-guided pericapsular nerve group (PENG) block, in which local anesthetic is injected near the nerves that carry pain signals from the hip joint. Participants will be assigned to one of the two groups by chance. Sixty-four adults aged 18 to 65 years will take part, with 32 in each group. Pain scores at rest and during movement, the total amount of morphine used through a patient-controlled pump, the time until the first request for extra pain medicine, the amount of additional paracetamol used, side effects such as nausea and vomiting, and complications related to the block will be compared between the groups during the first 48 hours after surgery.

Conditions

Hip Arthroplasty, Total; Postoperative Pain; Hip Arthroplasty; Analgesia; Hip Fractures (ICD-10 72.01-72.2)

Keywords

Arthroplasty; Hip Analgesia; Nerve Block

Outcome Measures

Primary Outcomes (1)

• Cumulative intravenous morphine consumption at 24 hours

  Total amount of morphine, in milligrams, delivered by the intravenous patient-controlled analgesia device during the first 24 postoperative hours, recorded from the device log. Lower values indicate lower opioid requirement.

  0 to 24 hours after surgery

Secondary Outcomes (7)

• Cumulative intravenous morphine consumption at 48 hours

  0 to 48 hours after surgery

• Pain intensity at rest measured with the Visual Analog Scale

  1, 3, 6, 12, 24 and 48 hours after surgery

• Pain intensity on movement measured with the Visual Analog Scale

  1, 3, 6, 12, 24 and 48 hours after surgery

• Time to first patient-controlled analgesia demand

  0 to 48 hours after surgery

• Cumulative paracetamol consumption

  0 to 48 hours after surgery

Study Arms (2)

Intrathecal Morphine Group

ACTIVE COMPARATOR

Patients receive spinal anesthesia with 10 mg hyperbaric bupivacaine 0.5% plus 100 micrograms of preservative-free morphine into the intrathecal space.

Drug: Morpine; Drug: Bupivacaine

PENG Block Group

EXPERIMENTAL

Patients receive spinal anesthesia with 10 mg hyperbaric bupivacaine 0.5% alone, followed by an ultrasound-guided pericapsular nerve group (PENG) block on the operated side with 20 mL of 0.5% bupivacaine.

Procedure: Ultrasound-guided pericapsular nerve group block; Drug: Bupivacaine

Interventions

Morpine DRUG

Preservative-free morphine hydrochloride 100 micrograms will be added to 10 mg of hyperbaric bupivacaine 0.5% and administered into the intrathecal space at the L3-L4 or L4-L5 interspace as part of spinal anesthesia.

Also known as: Morphine hydrochloride, ntrathecal morphine

Intrathecal Morphine Group

Ultrasound-guided pericapsular nerve group block PROCEDURE

After spinal anesthesia, an ultrasound-guided pericapsular nerve group block will be performed on the operative side. A 21 gauge, 80 to 100 mm echogenic needle will be advanced in-plane from lateral to medial into the fascial plane between the iliopubic eminence and the iliopsoas tendon, and 20 mL of bupivacaine 0.5% will be injected after negative aspiration.

PENG Block Group

Bupivacaine DRUG

Hyperbaric bupivacaine 0.5%, 10 mg, will be administered intrathecally in both groups as the spinal anesthetic. In the PENG block group, an additional 20 mL of bupivacaine 0.5% will be used for the block.

Also known as: Bupivacaine hydrochloride

Intrathecal Morphine Group; PENG Block Group

Eligibility Criteria

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

You may qualify if:

• Age 18 to 65 years
• American Society of Anesthesiologists physical status I, II or III
• Scheduled for unilateral hip surgery under spinal anesthesia, including hip fracture surgery and hip replacement surgery
• Able to understand and use the Visual Analog Scale and the patient-controlled analgesia device
• Written informed consent

You may not qualify if:

• Refusal to participate
• Known allergy or hypersensitivity to local anesthetics, morphine or paracetamol
• Any contraindication to spinal anesthesia, including coagulopathy, ongoing anticoagulant therapy, thrombocytopenia, infection at the puncture site, or raised intracranial pressure
• Local infection or previous surgery at the pericapsular nerve group block site
• Chronic opioid use or history of substance use disorder
• Chronic pain requiring regular analgesic treatment before surgery
• Cognitive impairment, psychiatric disorder or communication difficulty preventing use of the pain scales
• Pre-existing neurological deficit in the operative lower limb
• Body mass index above 40 kg/m²
• Pregnancy or breastfeeding

Sponsors & Collaborators

• Selcuk University: lead

Study Sites (1)

Selcuk University Hospital

Konya, Selcuklu, Turkey (Türkiye)

RECRUITING

Related Publications (4)

• Liu SS, Wu CL. The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review. Anesth Analg. 2007 Sep;105(3):789-808. doi: 10.1213/01.ane.0000278089.16848.1e.

  PMID: 17717242 BACKGROUND

• Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.

  PMID: 30063657 BACKGROUND

• Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018 Feb;43(2):186-192. doi: 10.1097/AAP.0000000000000701.

  PMID: 29140962 BACKGROUND

• Pivec R, Issa K, Naziri Q, Kapadia BH, Bonutti PM, Mont MA. Opioid use prior to total hip arthroplasty leads to worse clinical outcomes. Int Orthop. 2014 Jun;38(6):1159-65. doi: 10.1007/s00264-014-2298-x. Epub 2014 Feb 27.

  PMID: 24573819 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Agnosia; Hip Fractures

Interventions

Bupivacaine

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Officials

• Inci KARA

  Selcuk University Hospital

  STUDY DIRECTOR

Central Study Contacts

NARGIZ MAMMADOVA

CONTACT

+90 552 886 23 56; dr.nergiz93@gmail.com

Inci KARA

CONTACT

+90 505 483 18 19; drincikara@yahoo.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: August 18, 2026
• First Posted: August 25, 2026
• Study Start: August 24, 2026
• Primary Completion: September 18, 2026
• Study Completion: September 25, 2026
• Last Updated: August 26, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)