Hip Arthroscopy, Postoperative Pain
Conditions
Keywords
pericapsular nerve group block, PENG, hip arthroscopy, pain
Brief summary
This randomized, double-blinded, placebo-controlled trial seeks to evaluate the analgesic efficacy of the pericapsular nerve group block in the setting of outpatient hip arthroscopy.
Detailed description
The pericapsular nerve group, or PENG block, has been recently described and shows promise in providing analgesia to the hip joint. The analgesic value of this block in the setting of hip arthroscopy is unknown. This study aims to compare a preoperative PENG block to placebo block prior to outpatient hip arthroscopy under general anesthesia. The primary outcome measure is immediate postoperative pain as measured by numerical rating score in the post-anesthesia care unit (PACU). Secondary outcomes include opioid consumption, opioid-related adverse events, patient satisfaction, chronic opioid usage, and pain scores at other time points.
Interventions
PROCEDUREPreop PENG block
Ultrasound-guided injection of 20 mL 0.5% ropivacaine according to the method described by Giron-Arango L in 2018. A needle is inserted at the inguinal level under ultrasound guidance to pass beneath the psoas tendon on top of the iliopubic eminence where the local anesthetic is injected.
PROCEDUREPlacebo block
Ultrasound-guided placebo injection of 5 mL 0.9% normal saline. Using the same landmarks as for the PENG group, a needle is inserted in the inguinal region under ultrasound guidance, whereby a subcutaneous injection of 5 mL of 0.9% saline is made.
DRUGRopivacaine 0.5% Injectable Solution
20 mL 0.5% ropivacaine will be injected for the preop PENG block
DRUGNormal Saline
5 mL 0.9% Normal saline will be injected for the Placebo block
Sponsors
University of Virginia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Subjects will be randomized to one of two groups with a computer generated arm assignment. The sealed envelopes will be opened immediately prior to nerve block. One group will receive a PENG block and the other will receive a placebo block. The provider performing the block will not be blinded, however all other members of the care team, the patient, and the investigator collecting data will be blinded to the randomization.
Intervention model description
Randomized, double blind, placebo controlled
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients \> 18 years old undergoing unilateral hip arthroscopy at the outpatient surgery center.
Exclusion criteria
* refusal to participate * \< 18 yo * Chronic opioid use * localized infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PACU pain score | Within 30 minutes of emergence from anesthesia. | Maximum pain score within the first 30 minutes after emergence in the post-anesthesia care unit. Pain will be assessed by numerical rating score (0-10, where 0 is no pain, and 10 is the worst possible pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PACU opioid consumption | Beginning with emergence from anesthesia and ending with discharge from the post-anesthesia care unit (typically 2 hours). | Total morphine milligram equivalents required by patients in the post-anesthesia care unit, prior to discharge from the outpatient surgery center. Following emergence from anesthesia, pain will be assessed in regular intervals, with administration of IV and oral opioids according to numeric rating scale and clinical assessment. Opioid administration stops when patient numerical rating score is \<4, when patient endorses manageable pain level, when side effects of opioids are intolerable, or for other concerning clinical conditions as determined by the anesthesiologist of record. |
| Nausea and Vomiting | Beginning with emergence from anesthesia and ending with discharge from the post-anesthesia care unit (typically 2 hours). | This is a yes/no binary outcome measure defined by administration of any antiemetic drug in the post-anesthesia care unit. |
| Patient satisfaction with analgesia | Determined through follow-up calls at 24 hours and 48-hours. | Patients will be called at 24 hours and 48 hours postoperatively. They will be asked during each call if they are satisfied with their pain control (binary - yes or no). |
| Postoperative opioid utilization | Determined through follow-up calls at 24 hours, 48 hours, and 1 week postoperatively | Cumulative postoperative opioid consumption expressed in morphine milligram equivalents |
| Postoperative pain scores | Determined through follow-up calls at 24 hours, 48 hours, and 1 week postoperatively | Postoperative numerical rating scores after discharge (0-10, where 0 is no pain, and 10 is the worst possible pain). |
Countries
United States
Outcome results
None listed