Pericapsular Nerve, Quadratus Lumborum, Total Hip Surgery
Conditions
Keywords
Total Hip Surgery, PENG block, QLB
Brief summary
Adequate pain management following total hip arthroplasty (THA) is a key component for patient satisfaction and early ambulation. However, due to the complexity of the innervation of the hip joint, the most appropriate anaesthetic and analgesic technique for THA remains unclear. A femoral nerve block is commonly performed and well established but is associated with motor weakness. Recently, the pericapsular nerve group (PENG) block has been introduced as an effective choice which targets the articular branches of the hip. The quadratus lumborum block (QLB) is a relatively new regional block that has been reported to provide effective analgesia for THA. The main objective of this study is to compare the effectiveness of the ultrasound-guided PENG block technique compared to QLB block in terms of efficacy of pain control and the safety profile after total hip arthroplasty under spinal anesthesia.
Detailed description
The patients will be randomly classified into two equal groups (40 patients each). Group allocation will be done by computer generated random numbers and closed opaque sealed envelopes. The study will be designed to be double blind as all patients and outcomes assessor will be blinded to group assignment. Patients will be randomized to one of three equal groups: Group I (n= 40 patients): Patients in this group will receive an ipsilateral single shot of QLB (30 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance. Group II(n= 40 patients): patients in this group will receive an ipsilateral single-shot of PENG block (25 ml of plain bupivacaine 0.25%) and LFCN block (5 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.
Interventions
DRUGPENG/LFCN and QL Blocks
Bupivacaine 0.25% injection
Sponsors
Konya Necmettin Erbakan Üniversitesi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The patient, and the outcomes assessor who performs postoperative pain evaluation will not know the group.
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
40 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
Physical status according to American Society of Anesthesiologists (ASA ) I-III
Exclusion criteria
* Younger than 40 years old and older than 85 * Patients undergoing general anesthesia * Allergy or intolerance to one of the study medications * Infection of the skin at the site of the needle puncture, * Patients who do not accept the procedure * History of bleeding diathesis * ASA IV, * Chronic gabapentin/pregabalin,opioid use * Hepatic or renal insufficiency * Previous operation on the same hip * BMI \>40
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Opioid consumption | Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours | Mean opioid consumption in morphine equivalents |
| Pain scores | Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours | Numerical Rating Scale-NRS (0 = no pain and 10 = worst imaginable painranged from 0 to 10) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quadriceps muscle strength | Postoperative 24 hours period | Quadriceps motor function will be tested with the patient supine and with the hip and knee flexed at 45º and 90º, respectively |
| Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression | Postoperative 24 hours period | Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depressio |
| Patient satisfaction | Postoperative 24 hours period | Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No |
Countries
Turkey (Türkiye)
Outcome results
None listed