Pericapsular Nerve Group and Lumbar Erector Spinae Plane Blocks for Geriatrics Undergoing Total Hip Arthroplasty

Not Applicable

Recruiting

• Conditions: Pericapsular Nerve; Lumbar Erector Spinae Plane Blocks; Geriatrics; Total Hip Arthroplasty; General Anesthesia
• Interventions: Drug: General anesthesia; Drug: Bupivacaine 0.5%

• Registration Number: NCT06904703
• Lead Sponsor: Tanta University

Brief Summary

This study will be conducted to evaluate the effect of pericapsular nerve group and erector spinae plane block as adjuvants to general anesthesia in geriatrics undergoing total hip arthroplasty.

Detailed Description

Total hip arthroplasty is one of the most common major orthopedic procedures to improve a patient's functional status and quality of life. Total hip arthroplasty is one of the most cost-effective and consistently successful surgeries performed in orthopedics and can be associated with significant postoperative pain.

General anesthesia may be considered more versatile and suitable for patients with complex medical histories or those who cannot tolerate spinal anesthesia. However, older patients undergoing hip fracture surgery under general anesthesia may experience a higher risk of postoperative delirium, prolonged sedation, and respiratory complications. Moreover, delayed mobilization is possible, leading to a higher incidence of complications such as deep vein thrombosis and pressure sores.

The target nerves of the hip joint arise from the lumbar plexus (L1-L4), the lumbosacral trunk of the sacral plexus (L4-L5), and the sacral spinal nerves (S1-S4) (7). The femoral nerve, obturator nerve, and the accessory obturator nerve supply the anterior capsule of the hip; the sciatic nerve and the nerve to the quadratus femoris mostly supply the articular branches to the posterior capsule of the hip joint The erector spinae plane block is a novel inter-fascial plane block targets the dorsal and ventral rami of the spinal nerves, is a newer regional anesthetic technique that can be used to provide analgesia for a variety of surgical procedures or to manage acute or chronic pain. This block can potentially provide analgesia to the posterior pelvis potentially safer alternative to epidural or paravertebral techniques, areas often involved in hip fracture pain.

The pericapsular nerve group block targets the articular branches of the femoral and obturator nerves near the hip joint capsule. By blocking these nerves, the pericapsular nerve group block effectively provides analgesia to the hip joint, particular tissues, and proximal femur.

Study Timeline

• Study Start: 2024-12-01
• Status Verified: 2025-03
• Study First Submitted: 2025-03-22
• Study First Submitted QC: 2025-03-29
• Last Update Submitted: 2025-03-29
• Study First Posted: 2025-04-01
• Last Update Posted: 2025-04-01
• Primary Completion: 2026-11-01
• Study Completion: 2026-11-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• Aged >75 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) classification I-III.
• Undergoing total hip arthroplasty under general anesthesia.

Exclusion Criteria

• Patient refusal.
• Body mass index (BMI) > 30 kg/m2.
• Allergy to local anesthesia drugs.
• Infection at the site of intervention.
• Coagulopathies.
• Preexisting advanced diseases of the kidney or liver.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
General anesthesia group	General anesthesia	Patients will receive general anesthesia.
Erector spinae plane block group	Bupivacaine 0.5%	Patients will receive general anesthesia and erector spinae plane block.
Pericapsular nerve block group	Bupivacaine 0.5%	Patients will receive general anesthesia and erector spinae plane block with pericapsular nerve block.

Primary Outcome Measures

Name	Time	Method
Mean sevoflurane MAC to achieve bispectral index (BIS) values (45-55)	Intraoperatively	Sevoflurane will be adjusted to maintain a steady state with a BIS value in the range of 45-55 and will be fixed through the study period

Secondary Outcome Measures

Name	Time	Method
Pain degree	24 hours postoperatively	Each patient will be instructed about postoperative pain assessment with the Numerical Rating Scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable").Pain intensity will be measured using a 10-point NRS at rest at 2, 4, 8, 12, 18, and 24 hours postoperatively.
Fentanyl consumption.	Intraoperatively	Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain).
Heart rate	Till the end of surgery (up to 2 hours)	HR will be recorded pre-induction of anesthesia, post-induction of anesthesia and before performing of block, and every 15 min till the end of surgery.
Total postoperative morphine consumption.	First 24 hours after surgery	Total postoperative morphine consumption in the first 24h after surgery will be recorded. Rescue analgesia of morphine will be given as 0.05mg/kg bolus if the Numerical Rating Scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4.
Arterial blood pressure	Till the end of surgery (up to 2 hours)	MAP will be recorded pre-induction of anesthesia, post-induction of anesthesia and before performing of block, and every 15 min till the end of surgery. Intraoperative arterial blood pressure will be assessed. Hypotension (decrease in basal mean arterial blood pressure by 20%) will be treated with IV fluid.
Patient satisfaction	24 hours after surgery	Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied). It will be assessed 24 hours after surgery.
Complications	24 hours Postoperatively	Complications such as bradycardia, hypotension, nausea, vomiting, pruritis, respiratory depression will be recorded.

Trial Locations

Locations (1)

Faculty of Medicine; 🇪🇬 Tanta, Egypt