PENG vs PHPB for Hip Arthroplasty Analgesia
Postoperative Analgesic Effectiveness of Pericapsular Nerve Block (PENG) and Posterior Hip Pericapsular Block (PHPB) in Hip Arthroplasty
Ankara City Hospital Bilkent
132 participants
Dec 1, 2025
OBSERVATIONAL
Conditions
Summary
Total hip arthroplasty (THA) is a commonly performed surgical procedure, and its incidence continues to rise with the aging population. Effective postoperative analgesia facilitates early mobilization and accelerates recovery. The pericapsular nerve group (PENG) block provides analgesia to the anterior hip capsule by targeting the articular branches of the femoral, obturator, and accessory obturator nerves. However, due to the contribution of sacral plexus-derived nerves (quadratus femoris, superior gluteal, and inferior gluteal nerves) to posterior hip pain, anterior blocks alone may be insufficient. This prospective study aims to compare the efficacy of preoperatively administered PENG block alone versus the combination of PENG and posterior hip pericapsular block (PHPB) in postoperative pain control after total hip arthroplasty. The primary outcome is postoperative pain intensity assessed by the Numerical Rating Scale (NRS). Secondary outcomes include the Quality of Recovery score (QoR-15), opioid consumption, manual muscle testing (MMT) results, time to mobilization, and block-related complications.
Eligibility
Inclusion Criteria5
- Patients scheduled for elective total hip arthroplasty (THA) under spinal anesthesia
- ASA physical status I-II
- Age ≥18 years
- Body Mass Index (BMI) between 18-35 kg/m²
- Patients who provide written informed consent
Exclusion Criteria18
- Age \<18 years
- ASA physical status ≥III
- Known allergy or contraindication to study medications (local anesthetics, opioids, etc.)
- Severe cardiac, renal, hepatic, or pulmonary failure
- Revision total hip arthroplasty
- Coagulopathy or anticoagulant use
- Local infection or neuropathic findings at the injection site
- Chronic inflammatory diseases or chronic corticosteroid use
- Diagnosed neuropsychiatric disorders
- Pregnancy or lactation
- Inability or unwillingness to read, understand, or sign the informed consent form
- Obesity (BMI \>35 kg/m²)
- Failed spinal anesthesia or conversion to general anesthesia
- Active malignancy or patients receiving radiotherapy/chemotherapy
- Active systemic infection or ongoing antibiotic therapy (except prophylaxis)
- Contraindication to regional anesthesia techniques
- Chronic opioid or analgesic use for pain disorders
- History of intracranial mass, increased intracranial pressure, epilepsy, cerebrovascular accident, neuromuscular disease, or motor/sensory deficits
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Interventions
Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule. In addition to the PENG block, a Posterior Hip Pericapsular Block (PHPB) will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The local anesthetic will be injected between the piriformis muscle and the ischiofemoral ligament to target the posterior articular branches of the quadratus femoris, superior gluteal, and inferior gluteal nerves. The combined PENG + PHPB approach aims to provide comprehensive analgesia of both the anterior and posterior hip capsule while preserving motor function.
Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule.
Locations(1)
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NCT07263932