Comparison of Pericapsular Nerve Group Block with Lateral Femoral Cutaneous Nerve Block and Quadratus Lumborum Block for Total Hip Arthroplasty
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 80
- Locations
- 1
- Primary Endpoint
- Pain scores
Study Overview
Brief Summary
Adequate pain management following total hip arthroplasty (THA) is a key component for patient satisfaction and early ambulation. However, due to the complexity of the innervation of the hip joint, the most appropriate anaesthetic and analgesic technique for THA remains unclear. A femoral nerve block is commonly performed and well established but is associated with motor weakness. Recently, the pericapsular nerve group (PENG) block has been introduced as an effective choice which targets the articular branches of the hip. The quadratus lumborum block (QLB) is a relatively new regional block that has been reported to provide effective analgesia for THA.
The main objective of this study is to compare the effectiveness of the ultrasound-guided PENG block technique compared to QLB block in terms of efficacy of pain control and the safety profile after total hip arthroplasty under spinal anesthesia.
Detailed Description
The patients will be randomly classified into two equal groups (40 patients each). Group allocation will be done by computer generated random numbers and closed opaque sealed envelopes. The study will be designed to be double blind as all patients and outcomes assessor will be blinded to group assignment.
Patients will be randomized to one of three equal groups:
Group I (n= 40 patients): Patients in this group will receive an ipsilateral single shot of QLB (30 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.
Group II(n= 40 patients): patients in this group will receive an ipsilateral single-shot of PENG block (25 ml of plain bupivacaine 0.25%) and LFCN block (5 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Masking Description
The patient, and the outcomes assessor who performs postoperative pain evaluation will not know the group.
Eligibility Criteria
- Ages
- 40 Years to 85 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Physical status according to American Society of Anesthesiologists (ASA ) I-III
Exclusion Criteria
- •Younger than 40 years old and older than 85
- •Patients undergoing general anesthesia
- •Allergy or intolerance to one of the study medications
- •Infection of the skin at the site of the needle puncture,
- •Patients who do not accept the procedure
- •History of bleeding diathesis
- •Chronic gabapentin/pregabalin,opioid use
- •Hepatic or renal insufficiency
- •Previous operation on the same hip
Arms & Interventions
Group PENG+LFCN Block
A linear probe will be placed on the anterior inferior iliac crest in the transverse plane while the patient is in the supine position. After rotating 45 degrees, the pubic ramus, femoral artery and psoas muscle will be visualized. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and the iliopubic eminence After a negative aspiration test, 25 ml bupivacaine 0.25% will be injected.
Then, the lateral femoral cutaneous nerve (LFCN) block was performed using linear US probe (10-18 MHz).The LFCN will be localized, infero-medially to the antero-superior iliac spine, laterally to the sartorius muscle and 5 ml of bupivacaine 0.25% will be carefully injected.
Intervention: PENG/LFCN and QL Blocks (Drug)
Group QL Block
A convex transducer will be placed in the transverse plane on the flank cranial to the iliac crest to visualise the transverse process of the 4th lumbar vertebra, erector spina, quadratus lumborum and psoas muscles as a 'Shamrock sign'. The needle will inserted in to the fascial plane between the quadratus lumborum and psoas muscles and 30 ml bupivacaine 0.25% will be administered.
Intervention: PENG/LFCN and QL Blocks (Drug)
Outcomes
Primary Outcomes
Pain scores
Time Frame: Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours
Numerical Rating Scale-NRS (0 = no pain and 10 = worst imaginable painranged from 0 to 10)
Opioid consumption
Time Frame: Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours
Mean opioid consumption in morphine equivalents
Secondary Outcomes
- Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression(Postoperative 24 hours period)
- Patient satisfaction(Postoperative 24 hours period)
- Quadriceps muscle strength(Postoperative 24 hours period)
Investigators
Alper Kilicaslan
Clinical Professor
Konya Necmettin Erbakan Üniversitesi