The Utility of Pericapsular Nerve Group (PENG) Block versus Intrathecal Morphine for Postoperative Analgesia in Anterior Approach Total Hip Arthroplasty: A Multicentre Triple Blinded Randomised Controlled Trial
Tim Cheok
70 participants
Feb 17, 2025
Interventional
Conditions
Summary
Multimodal pain relief forms part of the early rehabilitation protocol in patients undergoing hip replacement. This has been shown to reduce complications and improve outcomes. The pericapsular nerve group (PENG) block is a new type of regional nerve block, which is associated with fewer side effects, than the currently used intrathecal morphine. Its efficacy in providing pain relief has not been demonstrated in anterior hip replacement. The primary aim of our project is to compare the postoperative pain relief provided by these techniques, at 3- and 24-hours following surgery, in patients undergoing anterior hip replacement. The secondary aim of our project is to compare the side effect profile, opioid utilisation, time to mobilisation, hospital length of stay, standardised patient reported outcome measures (PROMs) and patient satisfaction.
Eligibility
Inclusion Criteria1
- All adult patients above the age of 18 years old presenting for primary elective anterior approach Total Hip Arthroplasty (THA) under spinal anaesthesia will be invited to participate in our study. Included participants must be able to provide informed consent and reliably report symptoms to the research team.
Exclusion Criteria1
- We will exclude patients who are (1) unable to provide first party consent (e.g., due to cognitive impairment or language barrier), (2) procedure not performed via an anterior approach, (3) contraindications for any of the following: spinal, intrathecal morphine or PENG block (e.g. therapeutic anticoagulation, anaphylaxis to local anaesthetics or morphine), (4) patient refusal of spinal anaesthesia and/or regional analgesia, and (5) clinical indications for general anaesthesia rather than spinal anaesthesia.
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Interventions
PENG Group: The block will be placed using ultrasound guidance with a curvilinear probe (2.5-5 MHz). 20 mL of ropivacaine 0.5% (100 mg) prepared by the anaesthesiologist performing the block will be used. The area is aseptically prepped and draped. The curvilinear probe will be placed transversely, medial to the anterior inferior iliac spine with the medial end of the probe rotated in a caudad direction to align to the superior pubic ramus. A 100 mm Sonoplex needle will be inserted in-plane under ultrasound guidance. 20 mLs of local anaesthetic (ropivacaine) will be injected as a plane block between the psoas fascia and superior pubic rami. A cross shall then be drawn on the skin with surgical marker to disguise the presence of a puncture site. Adherence will be monitored by auditing of anaesthesia records
Locations(1)
View Full Details on ANZCTR
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ACTRN12623001309673