Arthroplasty Total Hip Replacement, Pain Management
Conditions
Keywords
Total Hip Arthroplasty, Nerve Block, Postoperative Analgesia, QLESP Block, PENG Block
Brief summary
Total hip arthroplasty (THA) is a common surgery to replace damaged hip joints, but many patients experience significant pain after surgery, which can delay recovery and increase the need for strong pain medications (opioids). Nerve blocks are a technique where anesthetic medication is injected near specific nerves to reduce pain. This study compares two different ultrasound-guided nerve block techniques for pain control after THA: the QLESP block (a newer technique that targets two areas with a single injection) and the PENG block combined with the LFCN block (a currently used technique that targets nerves around the hip joint and the outer thigh). Participants in this study will be randomly assigned (like a coin flip) to receive either the QLESP block or the PENG+LFCN block after surgery. The study aims to determine which nerve block provides better pain relief and reduces the need for opioid pain medications in the first 24 hours after surgery. Pain scores, recovery of leg movement, time to first walk, length of hospital stay, and any side effects will also be compared between the two groups.
Interventions
PROCEDUREQLESP Block
Ultrasound-guided quadratus lumborum and modified erector spinae plane block. A single-puncture, dual-injection technique at the L4 level. Total volume: 30 mL of 0.375% ropivacaine.
PROCEDUREPENG+LFCN Block
Ultrasound-guided pericapsular nerve group block combined with lateral femoral cutaneous nerve block. PENG: 20 mL of 0.375% ropivacaine; LFCN: 10 mL of 0.375% ropivacaine.
DRUGropivacaine
Ropivacaine hydrochloride injection, 0.375% solution, administered as a single dose via ultrasound-guided nerve block. Total dose: 112.5 mg (30 mL of 0.375% solution) for the QLESP group; 112.5 mg (30 mL of 0.375% solution) for the PENG+LFCN group.
Sponsors
Huazhong University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Participants are randomly assigned in a 1:1 ratio to receive either QLESP block or PENG combined with LFCN block
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 to 70 years * Scheduled for elective unilateral total hip arthroplasty via posterolateral approach * American Society of Anesthesiologists (ASA) physical status I-III * Body mass index (BMI) \< 35 kg/m² * Ability to understand pain scoring and patient-controlled analgesia (PCA) use * Willing and able to provide written informed consent
Exclusion criteria
* Allergy or hypersensitivity to local anesthetics (ropivacaine) * Long-term opioid use or chronic pain history requiring regular analgesic use * Active malignancy or infection at the puncture site * Severe psychiatric disorders or communication barriers * Severe cardiopulmonary disease * History of opioid abuse or substance dependence * Participation in another interventional clinical trial within 3 months prior to enrollment * Coagulation abnormalities * Pregnancy or breastfeeding * Any condition that, in the investigator's opinion, would compromise patient safety or data integrity
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Postoperative 24-Hour Cumulative Opioid Consumption | At 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rescue Analgesia Requirement | Within 24 hours after surgery | — |
| Motor Block Assessment (Bromage Score) | At 6, 24, and 48 hours after surgery | The Bromage Score is a 4-point scale ranging from 0 (no motor block, able to perform full knee flexion and foot dorsiflexion against resistance) to 3 (complete motor block, unable to move knee or foot). Higher scores indicate worse motor function. Assessed on the operative side at each time point. A score of 0-1 is considered clinically acceptable for early ambulation. |
| Postoperative VAS Pain Scores | At 6, 12, 24, 36, and 48 hours after surgery | The Visual Analogue Scale (VAS) is a 10-cm line ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate worse pain. Pain scores are assessed at rest and during movement (passive hip flexion to 15 degrees) at each time point. |
| Length of Hospital Stay | From surgery date to discharge, up to 30 days | — |
| Incidence of Adverse Events | From surgery end to 48 hours after surgery | — |
| Time to First Ambulation | From surgery end to first walk, up to 7 days | — |
Countries
China
Contacts
CONTACTXi Wu
Outcome results
None listed