Hip Arthritis, Hip Arthropathy, Hip Osteoarthritis
Conditions
Brief summary
This randomized controlled trial investigates the impact of local anesthetic volume and perineural dexamethasone on the analgesic and anti-inflammatory effectiveness of the pericapsular nerve group (PENG) block in patients undergoing total hip arthroplasty (THA). Patients were randomized to receive one of four PENG block variants differing in ropivacaine volume (10 mL or 20 mL of 0.2%) and the addition of 4 mg of perineural dexamethasone. The study evaluates postoperative pain, opioid requirements, systemic inflammatory markers, and quadriceps motor preservation.
Detailed description
The pericapsular nerve group (PENG) block has become a widely used motor-sparing component of multimodal analgesia for total hip arthroplasty (THA). However, its optimal formulation-particularly the volume of local anesthetic and the role of adjuvants-remains undetermined. This prospective, double-blind, randomized controlled trial evaluates the influence of ropivacaine volume (10 mL vs. 20 mL of 0.2%) and the addition of perineural dexamethasone (4 mg) on analgesic efficacy, opioid consumption, systemic inflammation, and quadriceps strength preservation. A total of 120 adult patients undergoing unilateral THA under spinal anesthesia were randomized to one of four PENG block groups: Group 1: 20 mL of 0.2% ropivacaine (standard-volume PENG) Group 2: 20 mL of 0.2% ropivacaine + 4 mg perineural dexamethasone Group 3: 10 mL of 0.2% ropivacaine (low-volume PENG) Group 4: 10 mL of 0.2% ropivacaine + 4 mg perineural dexamethasone The primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included total 48-hour opioid consumption (expressed in oral morphine equivalents), numeric rating scale (NRS) pain scores, quadriceps muscle strength, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) at 12, 24, and 48 hours postoperatively. Results demonstrated that the addition of dexamethasone, regardless of volume, significantly prolonged the duration of analgesia and reduced opioid consumption compared to non-adjuvanted PENG blocks. The low-volume + dexamethasone group achieved comparable analgesia to high-volume protocols with better inflammatory profiles. Quadriceps strength was preserved in all groups. These findings support the use of perineural dexamethasone as an effective enhancer of PENG block analgesia while enabling lower local anesthetic volume, potentially improving safety and recovery outcomes in THA patients.
Interventions
DRUGRopivacaine 0.2% Injectable Solution
20ml 0.2% Ropivacaine
DRUGDexamethasone 4mg
perineural 4mg Dexamethasone
Sponsors
Poznan University of Medical Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged ≥18 years scheduled for primary unilateral total hip arthroplasty (THA). * American Society of Anesthesiologists (ASA) physical status I-III. * Ability to provide written informed consent. * Spinal anesthesia planned as the primary anesthetic technique. * Body mass index (BMI) between 18 and 35 kg/m². * Fluent in the local language and able to understand the NRS pain scoring system.
Exclusion criteria
* Known allergy or hypersensitivity to ropivacaine, dexamethasone, or other amide local anesthetics. * Pre-existing neurological deficits or neuropathies affecting lower limb motor or sensory function. * Chronic opioid use (daily use \>30 mg oral morphine equivalents for \>1 month prior to surgery). * History of coagulopathy, current anticoagulant therapy not eligible for regional anesthesia. * Uncontrolled diabetes mellitus (HbA1c \> 9%) or active systemic infection. * Pregnancy or breastfeeding. * Previous surgery or implantation on the ipsilateral hip. * Inability to cooperate with postoperative assessments or participate in follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first rescue opioid | 24 hours after surgery | Time after surgery when the patient needs opiate for the first time |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total 48h opioid consumption | 48 hours after surgery | Total opiate consumption after surgery |
| Numerical Rating Scale [range 0:10] | 4 hours after surgery | Postoperative pain assessment will be performed using the NRS score (0 = no pain, 10 = the most severe pain felt) |
| NLR | 12 hours after surgery | neutrophile-to-lymphocyte ratio |
| PLR | 12 hours after surgery | platelet-to-lymphocyte ratio |
| Quadriceps strength | 4 hours after surgery | Quadriceps muscle strength (knee extension and hip adduction) will be evaluated according to the medical research council muscle strength rating |
| blood glucose | 12 hours after surgery | blood glucose level |
| Nerve damage | 12 hours after surgery | Nerve damage assesment will be performed using the nerve damage score (N0- no nerve damage; N1- minor - sensory paresthesia; N2- major -complete sensory anesthesia; N3- Complete- complete motor defect with or without paraesthesia; N4-CRPS- Complex Regional Pain Syndrome) |
Countries
Poland
Contacts
STUDY_CHAIRMalgorzata Reysner, M.D. Ph.D.
Poznan University of Medical Sciences
Outcome results
None listed