Hip Arthropathy, Hip Osteoarthritis, Hip Pain Chronic
Conditions
Brief summary
The goal of this clinical trial is to evaluate whether different types of regional anesthesia can improve pain control and functional recovery after total hip arthroplasty in adult patients undergoing elective hip replacement surgery. The main questions it aims to answer are: Does the PENG block reduce opioid use in the first 48 hours after surgery more effectively than the combined L-ESPB + S-ESPB technique? Which method provides better pain relief, preserves muscle strength, and supports earlier mobilization? Researchers will compare the Pericapsular Nerve Group (PENG) block with the combination of Lumbar and Sacral Erector Spinae Plane Blocks (L-ESPB + S-ESPB) to see which provides better pain control, fewer side effects, and faster recovery. Participants will: Be randomly assigned to receive one of the two types of ultrasound-guided regional anesthesia Undergo standard hip replacement surgery under spinal anesthesia Be monitored for pain scores, opioid use, time to first walking, muscle strength, satisfaction, and side effects over the first 48 hours after surgery.
Detailed description
Total hip arthroplasty (THA) is associated with moderate-to-severe postoperative pain, which can impair early mobilization and functional recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) block and the erector spinae plane (ESP) block, have been introduced as motor-sparing alternatives to femoral and lumbar plexus blocks. The PENG block targets articular branches of the femoral, obturator, and accessory obturator nerves, offering effective analgesia with minimal motor blockade. Meanwhile, the lumbar ESPB (L-ESPB) and sacral ESPB (S-ESPB) may provide a broader, yet still motor-sparing, analgesic field by targeting both lumbar and sacral nerve roots involved in hip innervation. To date, no randomized trial has compared PENG with a dual-level ESP block approach (L-ESPB + S-ESPB) in THA patients.
Interventions
DRUGRopivacaine 0.5% Injectable Solution
All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.
DRUGRopivacaine 0.2% Injectable Solution
Ultrasound-guided pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block, with sham lumbar and sacral ESPBs. PENG block: 20 mL of 0.2% ropivacaine. LFCN block: 5 mL of 0.2% ropivacaine. Sham lumbar ESPB: 1-2 mL preservative-free normal saline at lumbar ESPB site. Sham sacral ESPB: 1-2 mL preservative-free normal saline at sacral ESPB site. All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.
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
65 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 65 years * ASA physical status I-III * Elective unilateral THA via posterior or lateral approach * Informed consent provided
Exclusion criteria
* Allergy to study drugs (ropivacaine, dexamethasone) * Chronic opioid use (\>30 MME/day) * Coagulopathy or infection at the injection site * BMI \> 40 kg/m² * Pre-existing motor weakness or neuropathy in the affected limb * Cognitive impairment precluding informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption | first 48 hours postoperatively | morphine milligram equivalents (MME) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to ambulation | 48 hours after surgery | Time to ambulation is defined as the time interval (in hours) from the end of surgery (skin closure) to the patient's first successful attempt at ambulation with or without assistance, as determined by the attending physiotherapist or nursing staff. |
| Quadriceps muscle strength | 4 hours after surgery | Quadriceps muscle strength assessed using medical research council scale \[range 0:5\] |
| Pain scores | 4 hours after surgery | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization |
Countries
Poland
Contacts
CONTACTMalgorzata Reysner, M.D. Ph.D.
STUDY_CHAIRMalgorzata Reysner
Poznan University of Medical Sciences
PRINCIPAL_INVESTIGATORTomasz Reysenr, M.D.
Poznan Univesity of Medical Sciences
Outcome results
None listed