Avascular Necrosis of Femur Head, Dysplasia of Hip Joint, Hip Osteoarthritis, Hip Surgeries, Osteonecrosis of the Femoral Head
Conditions
Brief summary
In the clinic, total hip arthroplasty is a frequently performed surgical procedure that often results in moderate to severe postoperative pain. Multimodal analgesia approaches are commonly preferred for managing this pain, and in recent years, nerve blocks targeting pelvic innervation have become increasingly prominent. Among these, the Pericapsular Nerve Group (PENG) block has gained attention for providing effective analgesia by targeting the nerves responsible for the anterior innervation of the hip capsule. However, when used alone, the PENG block may be insufficient for controlling posterior hip pain and may not provide complete analgesia. In this context, adding blocks targeting the superior cluneal nerve and the superior gluteal nerve-both of which contribute to the sensory innervation of the posterior hip region-has been proposed to enhance the analgesic effect when combined with the PENG block. Superior cluneal and superior gluteal nerve blocks have recently been described in anatomical and clinical studies, and by affecting the structures contributing sensory input to the posterior hip capsule, they hold significant potential for improving pain management. In this study, the investigators aimed to evaluate the contribution of superior cluneal and superior gluteal nerve blocks, when added to the PENG block, to perioperative analgesia in patients undergoing total hip arthroplasty. The investigators sought to comparatively investigate whether this combination offers superior outcomes compared with the PENG block alone. It was hypothesized that combined nerve blocks may provide similar or improved recovery scores, lower pain scores, reduced opioid consumption, and enhanced analgesic efficacy without affecting the degree of motor blockade.
Interventions
DRUG15 ml Bupivacaine Hcl 0.25% injection
For PENG Block, 15 mL of 0.25% bupivacaine will be administered.
DRUG20 mL bupivacaine 0.25% injection
After performing PENG; 10 mL of 0.25% bupivacaine will be administered for each superior cluneal nerve block and superior gluteal nerve block
Sponsors
Ataturk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Voluntary participation in the study * Age between 18 and 80 years * ASA physical status I, II, or III * Male or female patients
Exclusion criteria
* Refusal to participate in the study * Allergy to the medications to be used * History of severe cardiac, renal, or hepatic disease * Presence of neurological deficits or neuropathy * History of anticoagulant use * Previous surgery in the inguinal or suprainguinal region * Pregnancy * Chronic opioid use at home * History of spinal surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| QoR-15 (Quality of Recovery-15) questionnaire | 24th and 48th postoperative hour | The primary outcome measure will be the QoR-15 (Quality of Recovery-15) questionnaire administered at the 24th postoperative hour. QoR-15 is a validated 15-item short survey assessing patients' postoperative physical comfort, emotional state, level of independence, pain control, and overall well-being. The total score obtained will be used to compare the overall quality of recovery between groups. The same questionnaire will be repeated at the 48th postoperative hour. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quadriceps Motor Block Assessment | It will be assessed at the 4th, 8th, 12th, and 24th postoperative hours. | Motor block will be assessed using the following 3-point scale: 0 = Normal strength (dorsiflexion against gravity and resistance) 1. = Paresis (dorsiflexion against gravity only, not against resistance) 2. = Paralysis (dorsiflexion not possible) |
| Motor Block Assessment at the Tibialis Anterior Muscle for the Sciatic Nerve | It will be assessed at the 4th, 8th, 12th, and 24th postoperative hours. | Motor block will be assessed using the following 3-point scale: 0 = Normal strength (dorsiflexion against gravity and resistance) 1. = Paresis (dorsiflexion against gravity only, not against resistance) 2. = Paralysis (dorsiflexion not possible) |
| Fentanyl consumption | The first 24 postoperative hours | Fentanyl consumption will be recorded via the PCA device during the postoperative intervals of 0-4, 4-8, and 8-24 hours. Total opioid consumption will be calculated at the 24th postoperative hour. |
| VAS pain scores | The first 24 postoperative hours | VAS pain scores will be assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, both at rest and during movement. The region where the patient experiences the most intense pain will be recorded as either the anterior or posterior hip. |
Countries
Turkey (Türkiye)
Outcome results
None listed