Hip Arthropathy
Conditions
Keywords
PENG block, intra-artikuler, Quadrotus lumborum block, Hip Arthropathy
Brief summary
90 patients ASA I-III, undergoing Total hip arthroplasty (THA) under spinal anesthesia, will be randomly assigned into one of three groups, namely group A (n=30), where an PENG block, group B (N:30) where an inra-articuler, and group C (n=30) where Quadratus lumborum block will be performed preoperatively. All patients will receive a standardized postoperative analgesia regimen. NRS scores will be evaluated in static and dynamic conditions during the first 48 hours postoperatively.
Detailed description
Total hip arthroplasty (THA) is the second most common joint replacement surgery, partly due to the aging population. The primary aim of this study is to compare the analgesic efficacy of Pericapsular nerve group (PENG) block with intra-articular and Quadrotus lumborum block (QLB). Regional anesthesia (RA), such as the recently described pericapsular nerve group (PENG) block, may provide additional analgesic benefit in this situation. Pericapsular nerve group (PENG) block is a new regional anesthesia technique to provide analgesia after hip fractures and hip arthroplasty. The aim of this single-center, double-blind, randomized controlled trial is to confirm the efficacy of PENG block for postoperative recovery after primary THA. Routine multimodal analgesia will be used for postoperative analgesia
Interventions
PROCEDUREGroup A
PENG BLOCK
PROCEDUREGroup B
Intra-articular
PROCEDUREGroup C
Quadratus lumborum block
Sponsors
Karaman Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
Yes
Inclusion criteria
* Physical status according to American Society of Anesthesiologists (ASA ) I-III
Exclusion criteria
* Previous operation on the same hip * Hepatic or renal insufficiency * Younger than 18 years old and older than 85 * Patients undergoing general anesthesia * Allergy or intolerance to one of the study medications * BMI \>40 * ASA IV * Chronic gabapentin/pregabalin use ( regular use for longer than 3 months) * Chronic opioid use ( taking opioids for longer than 3 months, or daily oral morphine equivalent of \>5 mg/day one month
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numerical Rating Scale (NRS) scores | 48 Hours | Range 0-10, 0=no pain, 10=the worse pain ever |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Static and dynamic pain | 3-6-8-12-24 and 48 hours | Pain intensity at rest and during active movement using a numeric rating score (NRS) 0 = no pain and 10 = worst imaginable painranged from 0 to 10 |
| Presence of quadriceps motor block (defined as paralysis or paresis ) | 3-6-12-24 hours after the block | Quadriceps motor function will be tested with the patient supine and with the hip and knee flexed at 45º and 90º, respectively. The subject will be asked to extend the knee first against gravity and then against resistance. Quadriceps strength will be graded according to a 3-point scale: normal strength = 0 point (extension against resistance); paresis = 1 point (extension against gravity but not against resistance); and paralysis = 2 points (no extension). |
| Hip adduction strength | 3-6-12-24 hours after the block | Hip adduction will be evaluated by comparing it to baseline strength (i.e., prior to spinal anesthesia). A blood pressure cuff, inflated at 40 mmHg, will be inserted between the knees of the patient: the latter will then be instructed to squeeze the cuff as hard as possible and to sustain the effort. We will define hip adduction scores of 0, 1 and 2 points as decreases in strength of 0-20%, 21-70% and 71-90% compared to baseline measurement, respectively |
| Opioid consumption | 3-6-8-12-24 and 48 hours | Analgesic consumption |
| Patient satisfaction | 48 hours | Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No |
| Quality of Recovery (QoR-40) score | measurements are obtained at 24 hours, 48 hours, and one week | QoR-40, a 40-item questionnaire that provides a global score and sub-scores across five dimensions: patient support, comfort, emotions, physical independence, and pain. Each item is rated on a scale of 1-5, providing a minimum score of 40 and maximum of 200. |
| Mobilization time | 24 hour | Mobilization time |
| Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression | 3-6-12-24 hours after the block | Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depressio |
Countries
Turkey (Türkiye)
Outcome results
None listed