A Comparative Study Between Ultrasound Guided Erector Spinae Plane Block and Combined Ultrasound Guided Pericapsular Nerve Group (PENG) and Lateral Femoral Nerve Block Following Total Hip Arthroplasty
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Ain Shams University
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- individual visual analog pain scores at 0, 6, 12, 24 and 48 h postoperatively (VAS; 0 = no pain and 10 = worst pain imaginable).
Study Overview
Brief Summary
The patients will be randomized into 2 equal groups by a computer-generated random numbers table, named group A, B.
Group A: patients will receive Pericapsular nerve group block and lateral femoral cutaneous nerve blocks.
Group B: Patients will receive Erector spinae plane block.
After IV access insertion and oxygen nasal cannula application, monitoring will be applied for all patients, sedation in the form of midazolam 0.02mg/kg with or without fentanyl 0.5-1 mcg/kg will be administered to any of the patients who felt discomfort or could not tolerate the procedure.
For (Group A) PENG block will be done before spinal anesthesia.
LFCN block will be performed.
For (Group B), ESP block will be done before spinal anesthesia.
Spinal anesthesia will be chosen as the main anesthetic technique.
In postoperative period all patients will receive the same adjuvant multimodal analgesia which will be 1000 mg of paracetamol with or without 30 mg ketorolac depending on comorbidities and depending on the patients" needs.
Detailed Description
The patients will be randomized into 2 equal groups by a computer-generated random numbers table, named group A, B.
Group A: patients will receive PENG and LFCN blocks.
Group B: Patients will receive ESP block, which will be the control group.
After obtaining approval from Ain Shams hospital academic and ethical committee, written, informed and valid consent will be taken from all participants after proper explanation of the study procedure and the expected outcome in a clear language for patients of either sex, aging from 18 to 65 years old, ASA physical status (I, II) scheduled for total hip arthroplasty surgeries.
Patients with the following criteria will be excluded from the study: Patient refusal, ASA physical status III or more, known allergy to any of the study drugs, infection at the site of injection, history of cardiovascular, renal, hepatic or neuromuscular diseases, history of any psychiatric disorder, presence of any coagulopathy, chronic opioid, gabapentin or pregabalin use, BMI more than 35 kg/m2. Patients will be randomly assigned to either both PENG and LFCN blocks and ESP block with ultrasound guidance before spinal anesthesia.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Triple (Participant, Care Provider, Investigator)
Eligibility Criteria
- Ages
- 18 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients American Society of anesthesiologists' physical status (ASA) I to III.
- •Aged 18 to 65 years.
- •Both sexes.
- •Patients scheduled for total hip arthroplasty.
Exclusion Criteria
- •Patient refusal
- •ASA physical status III or more.
- •Patients with known allergy to any of the study drugs.
- •Infection at the site of injection.
- •Patients with history of cardiovascular disease.
- •Patients with renal disease.
- •Patients with hepatic disease.
- •Patients with neuromuscular disease.
- •Presence of any coagulopathy.
- •Chronic opioid, gabapentin or pregabalin use.
- •Patients with history of any psychiatric disorder.
- •BMI more than 35 kg/m2.
Arms & Interventions
Combined hip joint PENG block and LFCN block
Combined hip joint pericapsular nerve group block(PENG) and lateral femoral cutaneous nerve block
Intervention: PENG block (Procedure)
Combined hip joint PENG block and LFCN block
Combined hip joint pericapsular nerve group block(PENG) and lateral femoral cutaneous nerve block
Intervention: LFCN block (Procedure)
ESP block
Erector spinae plane block(ESP)
Intervention: ESP block (Procedure)
Outcomes
Primary Outcomes
individual visual analog pain scores at 0, 6, 12, 24 and 48 h postoperatively (VAS; 0 = no pain and 10 = worst pain imaginable).
Time Frame: 48 hours
The primary outcomes include : individual visual analog pain scores at 0, 6, 12, 24 and 48 h postoperatively (VAS; 0 = no pain and 10 = worst pain imaginable).
presence of moderate-to-severe pain, defined as pain score 4 or greater during the first 48 h postoperative.
Time Frame: 48 hours
presence of moderate-to-severe pain, defined as pain score 4 or greater during the first 48 h postoperative.
analgesic consumption in post-anesthesia care unit, and during the first 48 h post-surgery (converted to IV pethidine equivalents).
Time Frame: 48 hours
analgesic consumption in post-anesthesia care unit, and during the first 48 h post-surgery (converted to IV pethidine equivalents).
Secondary Outcomes
No secondary outcomes reported
Investigators
riham fathy galal
Lecturer
Ain Shams University