None listed
Conditions
Brief summary
We hypothesise that, in a surgical setting for hip arthroplasty, the PENG (pericapsular nerve group) regional block is more effective in reducing post-operative pain than placebo. We propose a study to investigate the effect of the PENG block, compared to placebo in a blinded format The participant, anaesthetist and surgeon will be blinded to the study medication administered. The post-operative pain team, at FMC and Noarlunga known as the Acute Pain Service (APS), will also be blinded. This team routinely follows up all participants who have undergone a hip arthroplasty. They will know that the participant has received a regional technique, but not whether it is with ropivacaine or placebo. Post-operatively, each participant will be visited on the ward by the Acute Pain Service which is a routine part of their care. In this consultation they will discuss their pain levels, pain medication use, and ability to mobilise since their surgery, all part of the standard questions asked by this service. As part of this study, Dr Lin (study investigator) shall post-operatively conduct a series of questionnaires, including one or more of the anxiety, depression and delirium assessments. In addition to this, we shall collect general information from the medical records, which will be kept confidential.
Interventions
For placement of the PENG block, a low frequency (2.5-5MHz) curvilinear ultrasound probe shall be used. The transducer is placed in a longitudinal plane with the lateral edge over the anterior inferior iliac spine of the hip. The median edge of the probe is rotated caudally to obtain an adequate view of the fascial plane under the psoas tendon along the acetabulum. A 21-Gauge 100mm Sonoplex needle (Pajunk, Geisingen, Germany) shall be inserted and an aspiration check performed prior to a 20 mL
For placement of the PENG block, a low frequency (2.5-5MHz) curvilinear ultrasound probe shall be used. The transducer is placed in a longitudinal plane with the lateral edge over the anterior inferior iliac spine of the hip. The median edge of the probe is rotated caudally to obtain an adequate view of the fascial plane under the psoas tendon along the acetabulum. A 21-Gauge 100mm Sonoplex needle (Pajunk, Geisingen, Germany) shall be inserted and an aspiration check performed prior to a 20 mL injection of local anaesthetic solution into the sub-psoas fascial plane. The local anaesthetic is ropivacaine 0.75%, unless the patient weighs less than 50 kilograms in which case the concentration is adjusted for a maximum of 3mg/kg, and volume maintained at 20mLs. The block shall be administered once prior to surgery. This shall be administered by an anaesthetist who has extensive clinical experience in this particular regional technique.
Sponsors
Flinders Medical Centre
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Hip arthroplasty surgery at Flinders Medical Centre or Noarlunga Hospital - aged 18 years or older - no contraindication to regional anaesthesia - able to give first party consent and provide reliable feedback on symptoms such as pain scores - Scheduled operative finishing time during standard hours. This is due to the availability of allied health staff, in particular physiotherapy who shall mobilise the patient initially.
Exclusion criteria
Exclusion criteria will be: - Aged under 18 years of age. - Inability to give first person consent - Inability to give consent or participate in post-operative assessments due to dementia, cognitive impairment and/or language barrier. - Allergy to chlorhexidine, or ropivacaine - Participant refusal of regional anaesthetic technique - contraindication to regional anaesthesia
Outcome results
None listed