Ultrasound-guided pericapsular nerve group block following hip arthroplasty for postoperative analgesia

Phase 2/3

Completed

Conditions: Medical and Surgical, (2) ICD-10 Condition: M169||Osteoarthritis of hip, unspecified,

Registration Number: CTRI/2023/10/058678

Lead Sponsor: Swami Rama Himalayan University

Brief Summary: Post operative pain is a major concern after any surgery. Immediate post operative period pain leads to delayed mobilisation and increased expenses due to a longer hospital stay. Inadequate analgesia after surgery is associated with increased incidences of chronic pain. Advanced techniques to provide multimodal analgesia like peripheral nerve blocks are being researched and published everyday. Newer avenues for perioperative pain control have been made possible by the use of ultrasonography in regional anaesthesia (1).

Acute post operative pain is a very common finding after hip surgeries and ranges all the way from moderate to severe. It is also a widely known risk factor for chronic pain in joint replacement surgeries (2).

Regional anaesthesia techniques that are currently being practised to manage post-operative pain in hip surgeries include epidural analgesia, femoral block, obturator block, sciatic block, fascia iliaca compartment block, erector spinae plane block and quadratus lumborum block. Epidural analgesia is still the approach of choice around the world but it does have its disadvantages which include hypotension, loss of bladder control, inadequate pain relief, bilateral block, prolonged motor nerve block and epidural hematoma (3).

The use of ultrasound guided regional analgesia is an upcoming and rapidly progressive method of pain management which allows for a far better management of post operative pain leading to reduced use of opioids in the post operative period along with reduction in their adverse effects like nausea, vomiting, somnolence and constipation (4).

Pericapsular Nerve Group (PENG) block is the latest technique used for hip surgeries which is gaining massive popularity due to its involvement of the obturator nerve and motor sparing capability.

Giron-Arango was the first to describe the ultrasound-guided Pericapsular Nerve Group (PENG) block. It is used to block all the sensory branches which are innervating the anterior capsule of the hip joint i.e. femoral, obturator, accessory branch of obturator nerve thereby minimising any motor impairment and allowing faster mobilization (5).

The musculo-fascial plane surrounded posteriorly by the pubic ramus and anteriorly by the psoas tendon is described as the blockâ€™s target site. With the patient in supine posture the ultrasound probe is first positioned in the transverse plane across the anterior superior iliac spine, and is then turned roughly 45 degrees counterclockwise. Before insertion of needle, the iliopubic eminence, iliopsoas muscle and tendon, femoral artery and pectinous muscle are brought into view and the musculo-fascial plane between the pubic ramus and psoas tendon is where the medication is injected (6,7).

Pericapsular Nerve Group Block has an added advantage of blocking the Obturator nerve and its accompanying branches, which supply the anterior capsule of the hip that are spared by other regional anaesthetic techniques, which primarily target the femoral nerve supplying the hip region only. Since the target area lies close to subpectineal plane, it is believed that the branches of the obturator nerve that supply the anterior capsule of the joint are successfully blocked along with the femoral and obturator nerve. With advances in ultrasound guidance, the Pericapsular Nerve Group (PENG) Block is one such modality that offers sensory block to all three nerve in a single injection site (8).

The ideal injection position, the best anaesthetic concentration, the overall volume of the medicine to be injected and combination with other blocks are topics that are still up for debate because of the novelty of this procedure. Latest research papers describe the use of PENG block in conjunction with local and intravenous analgesics for hip arthroplasty or hip arthroscopy (combined with lateral femoral cutaneous nerve LFCN block) and Hemiarthroplasty (comparing it with femoral block) (9).

Patient controlled analgesia pumps (PCA pump) is one modality that is given along with peripheral nerve blocks to reduce post operative pain as it freely allows the patient to control his desired level of analgesia that ultimately ends with patient satisfaction (10).

In this study we use preoperative PENG block on various types of hip surgeries and compare its effects with a control group using NRS scoring system for postoperative pain relief. Also we compare the total post operative analgesic consumption between the two groups and evaluate patient satisfaction using Likert scale between the two groups.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 56

Inclusion Criteria

Type of hip surgery- Total Hip Arthroplasty, Hemiarthroplasty, Revision Arthroplasty American Society of Anaesthesiologist (ASA) physical status Grade I and II.

Exclusion Criteria

Patient refusal for Regional Anaesthesia.
Known allergies to Local anaesthetics.
Bleeding disorders Infection at local site Severe Liver and kidney disfunction BMI above 30 kg/m2 Inability to give informed consent Inability to operate PCA pump Psychiatric Disorder.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Post Operative pain relief using NRS scoring scale	24 hours

Secondary Outcome Measures

Name	Time	Method
Total opioid consumption over 24 hours	Duration of the first rescue analgesic used over 24 hours (time from PACU discharge to first requested analgesic)

Trial Locations

Locations (1): Swami Rama Himalayan Institute, HIMS
🇮🇳
Dehradun, UTTARANCHAL, India
Swami Rama Himalayan Institute, HIMS
🇮🇳Dehradun, UTTARANCHAL, India
Rohan Bhatia
Principal investigator
9971014232
rohanbhatia@srhu.edu.in