Postoperative Pain Management After Total Hip Arthroplasty, Total Hip Arthroplasty (THA)
Conditions
Keywords
Anesthetics, Anesthetics, Local, Pain, Acute Pain, PENG block, Pelvic MRI, Regional anesthesia, Fascial plane, Local anesthetic spread
Brief summary
This study uses MRI imaging to evaluate the spread of local anesthetic following the administration of a pericapsular nerve group (PENG) block. The goal is to determine whether a distinct fascial plane exists between neurovascular structures, potentially explaining the block's observed clinical effectiveness.
Detailed description
The pericapsular nerve group (PENG) block has demonstrated promising clinical results in providing analgesia for hip-related pain, particularly in patients with femoral neck fractures or undergoing hip surgery. However, the exact mechanism of action and spread of local anesthetic remain poorly understood. This pilot study aims to use magnetic resonance imaging (MRI) to visualize the distribution pattern of the injectate after PENG block administration. High-resolution MRI scans will be obtained shortly after the procedure to assess the spatial relationship between the spread of local anesthetic, relevant anatomical structures (including the iliopsoas muscle, femoral artery, and femoral nerve), and potential fascial compartments. The findings will help to clarify the anatomic basis of the PENG block and may guide optimization of technique for enhanced clinical outcomes.
Interventions
PROCEDUREPENG Block
Preoperative ultrasound giuded PENG block (ropivacaine 0,5% 20mL)
PROCEDUREMagnetic resonance imaging
The patient will undergo a pelvic MRI to assess anesthetic diffusion after PENG block
Sponsors
Campus Bio-Medico University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for total hip replacement surgery * Age ≥ 18 years * ASA physical status classification I-III * Signed informed consent obtained * Orthopedic indication for preoperative MRI study
Exclusion criteria
* Allergy to local anesthetics * Infection at the planned puncture site * Refusal or inability to provide informed consent * Age \< 18 years * Claustrophobia * Altered consciousness or severe dementia * Presence of MRI-incompatible implanted devices (e.g., pacemakers implanted before 2000) * Pregnancy or breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Extent of local anesthetic spread as visualized on MRI after PENG block administration | 10 minutes after injection | MRI images will be used to assess the diffusion pattern of local anesthetic following PENG (Pericapsular Nerve Group) block. The assessment will focus on whether the anesthetic reaches a specific fascial plane between the femoral vessels and nerves. A radiologist will evaluate the extent and location of the anesthetic spread in relation to key anatomical landmarks (according to centimeter-based measurements as per MRI protocols). |
Countries
Italy
Outcome results
None listed