PENG Block Versus LP Block for Postoperative Analgesia After Anterior Total Hip
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 154
- 试验地点
- 1
- 主要终点
- Numeric Rating Scale (NRS) Pain Score
研究概览
简要总结
The purpose of this randomized, double blinded, prospective study is to compare the postoperative analgesia provided by the PENG block to that provided by the LPB for patients undergoing primary anterior approach THA.
详细描述
Regional anesthesia procedures represent a common modality for postoperative analgesia after total hip arthroplasty surgeries (THA). The standard practice many years has been the Lumbar Plexus block (LPB), which anesthetizes the L1-L5 lumbar nerve roots1. While the LPB offers analgesia from the associated sensory block, it also blocks motor fibers, leading to lower extremity weakness that could potentially delay the patient's ability to participate in early physical therapy and may thereby delay discharge. In the past several years, newer regional anesthesia block approaches have been described and investigated in an attempt to provide patients with postoperative analgesia while avoiding associated muscle weakness, facilitating earlier physical therapy participation and discharge. One such nerve block is the peri-capsular nerve group (PENG) block, which anesthetizes the articular branches of the femoral, obturator, and accessory obturator nerves providing sensory innervation to the hip joint capsule without consistently causing lower extremity weakness2. Some institutions are utilizing the PENG block to provide postoperative analgesia and facilitate early mobilization. There are currently no prospective studies that directly compare the efficacy of LPB to PENG block for providing postoperative analgesia after THA.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 90 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •elective primary total hip arthroplasty surgery anterior approach
- •provided informed consent
- •no contraindications to medications used in providing the analgesic blocks
排除标准
- •contraindications to regional anesthesia, such as an allergy to amide local anesthetics
- •pre-existing coagulopathy or thrombocytopenia <100,000
- •refusal of analgesic block for pain management
- •presence of an progressive lower extremity neurological deficit
- •localized or systemic infection
- •chronic use of high dose opioid analgesics (defined as daily use greater than 60 mg oxycodone equivalents)
- •refusal of consent
研究组 & 干预措施
Peri-capsular Nerve Group (PENG)
Those subjects assigned to the PENG treatment arm will receive a PENG block using 20mL of 0.2% ropivacaine with 1:400,000 epinephrine dosed in 5mL increments with negative aspiration beforehand and between each aliquot.
干预措施: Peri-capsular Nerve Group (PENG) (Drug)
Lumbar Plexus Block (LPB)
Those subjects assigned to the LPB treatment arm will receive a stimulation-based LPB dosed with 20cc of 0.2% ropivacaine with 1:400,000 dilution epinephrine dosed in 5mL increments with negative aspiration beforehand and between each aliquot.
干预措施: Lumbar Plexus Block (LPB) (Other)
结局指标
主要结局
Numeric Rating Scale (NRS) Pain Score
时间窗: hour 6
a comparison of patient-reported numeric rating scale (NRS) pain scores with movement at six hours following block placement. Equivalency will be defined as a difference of less than one point in either direction on the eleven-point NRS pain scale. Score ranges from 0-10 with a higher score denoting more pain.
次要结局
- NRS Pain Score(hour 24)
- Time in Minutes Until Opioid Administration(hour 24)
- Motor Strength(hour 6)
- Distance Ambulated(hour 24)