Analgesic Effectiveness of PENG Block in Programmed Hip Arthroplasty Surgery (THAPeng)

The intra- and peri-articular infiltration of local anaesthetics realized at the end of total hip arthroplasty surgeries is an effective analgesic technique, but it can be insufficient to manage the possibly intense postoperative pain. Regional anaesthesia (RA) like the recently described pericapsular nerve group (PENG) block could provide additional analgesic benefit in this setting.

Investigators main objective is to demonstrate the analgesic benefits (postoperative pain score and morphine consumption) of the PENG block when added to intra- and peri-articular infiltration of local anaesthetic following total hip arthroplasty. Investigators make the assumption that i) the PENG bloc could reduce the postoperative 24 first hours morphine consumption by 30%, ii) the PENG block could spare the motor function of the quadriceps and adductor muscles, and iii) the PENG bloc could be well tolerated allowing a high level of patient satisfaction.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain
• Intervention / Treatment: Procedure: ultrasound-guided PENG bloc realized before surgery

Detailed Description

A recent study has revealed a region of pericapsular terminal branches of the femoral nerve and the obturator nerve accessible to ultrasound-guided regional anaesthesia. This technique, also called the PENG block, has recently been described with a substantial benefit on pain at rest and induced by mobilization in cases series of patients undergoing hip fracture surgery. To investigators knowledge, no randomized data concerning the analgesic efficacy of the PENG block has been published in the setting of elective total hip arthroplasty.

The PENG block would allow a significant analgesic contribution when added to intra- and peri-articular infiltration of local anaesthetics while being well tolerated with few undesirable effects. Moreover, the PENG block could spare the motor function of the quadriceps and adductor muscles allowing enhanced recovery after surgery

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Toulouse, France
    • University Hospital of Toulouse

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Scheduled for total hip arthroplasty surgery under general anaesthesia
• Affiliated of a social security scheme
• Having signed the written informed consent

Exclusion Criteria:

• Total hip arthroplasty revision surgery
• Refusal of the patient to participate
• Existence of major spontaneous or acquired haemostasis disorders
• Infection at the puncture site
• Allergy to local anaesthetics
• Pregnancy or breast-feeding
• Patients under the protection of adults (guardianship, curatorship or protection of justice)
• Patients whose cognitive state does not allow assessment by the scales used.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PENG group; For the PENG group, the ultrasound-guided PENG block (20 ml of Ropivacaine 4.75 mg/ml) is performed before the surgery.	Procedure: ultrasound-guided PENG bloc realized before surgery; ultrasound-guided PENG block realized before surgery. The PENG block, described by Giron-Arebgi is made in the supine position. The ultrasound probe used is a 5 MHz high frequency linear probe placed parallel to the line delimited by the anterior-inferior iliac spine (lateral) and the pubis (medial). The needle used is an 80 mm, 22G, needle inserted in the ultrasound plane. The slow and fractioned injection of 20 ml of Ropivacaine 4.75 mg/ml is performed in the fascia between the psoas tendon and the iliopubic eminence under ultrasound guidance.
No Intervention: Control group; No additional intervention, only standard care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulated postoperative morphine consumption 24 hours after surgery	calcul of Cumulated postoperative morphine consumption 24 hours after surgery	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cumulated postoperative morphine consumption in the post anaesthesia care unit (PACU)	Cumulated postoperative morphine consumption in the post anaesthesia care unit (PACU)	Hour 1
Cumulated postoperative morphine consumption 48 hours after surgery	Cumulated postoperative morphine consumption 48 hours after surgery	Hour 48
Evaluation of pain in the PACU	Evaluation of pain using a simple numeric rating scale (NRS from 0 to 10) in the PACU	Hour 1
Evaluation of pain 24 hours after surgery	Evaluation of pain using a simple numeric rating scale (NRS from 0 to 10) 24 hours after surgery	Hour 24
Evaluation of pain 48 hours after surgery	Evaluation of pain using a simple numeric rating scale (NRS from 0 to 10) 48 hours after surgery	Hour 48
Evaluation of the pain potentially induced by the realization of the PENG block	Evaluation of the pain potentially induced by the realization of the PENG block with Likert scale from 1 to 5, 1 is for no pain, 5 is for the worse pain	Hour 0
Evaluation of adverse effects associated with the PENG block	Evaluation of adverse effects associated with the PENG block	Hour 0
Evaluation of adverse effects associated with the PENG block	Evaluation of adverse effects associated with the PENG block	Hour 1
Evaluation of adverse effects associated with the PENG block	Evaluation of adverse effects associated with the PENG block	Hour 24
Evaluation of adverse effects associated with the PENG block	Evaluation of adverse effects associated with the PENG block	Hour 48
Evaluation of adverse effects associated with the use of morphine	Evaluation of adverse effects associated with the use of morphine	Hour 0
Evaluation of adverse effects associated with the use of morphine	Evaluation of adverse effects associated with the use of morphine	Hour 1
Evaluation of adverse effects associated with the use of morphine	Evaluation of adverse effects associated with the use of morphine	Hour 24
Evaluation of adverse effects associated with the use of morphine	Evaluation of adverse effects associated with the use of morphine	Hour 48
Evaluation of the patients' satisfaction	Evaluation of the patients' satisfaction by the EVAN-LR score realized 24 hours after surgery. EVAN-LR is a scale assessing perioperative patient's satisfaction with Loco Regional anaesthesia	Hour 24
Evaluation of the adductor muscles weakness	Evaluation of the adductor muscles weakness by a thigh adduction test performed 24 hours after surgery	Hour 24
Evaluation of the quadricipital muscles weakness	Evaluation of the quadricipital muscles weakness by a Timed to Up and Go Test performed 24 hours after surgery	Hour 24

Collaborators and Investigators

• Sponsor: University Hospital, Toulouse
• Investigators: Principal Investigator: FERRE Fabrice, PH, University Hospital, Toulouse

Publications and helpful links

General Publications

• Ferre F, Rey J, Bosch L, Menut R, Ferrier A, Ba C, Halimi C, Collinson I, Tissot B, Labaste F, Reina N, Minville V. Pericapsular nerve group (PENG) block combined with local infiltration analgesia is not superior to local infiltration analgesia for the management of postoperative pain after primary elective total hip arthroplasty: A prospective, randomized, controlled, single-blind trial. Heliyon. 2024 Jun 27;10(13):e33766. doi: 10.1016/j.heliyon.2024.e33766. eCollection 2024 Jul 15.

Study record dates

Study Major Dates

• Study Start (Actual): December 14, 2020
• Primary Completion (Actual): July 8, 2021
• Study Completion (Actual): July 8, 2021

Study Registration Dates

• First Submitted: November 24, 2020
• First Submitted That Met QC Criteria: November 24, 2020
• First Posted (Actual): December 2, 2020

Study Record Updates

• Last Update Posted (Actual): November 28, 2025
• Last Update Submitted That Met QC Criteria: November 21, 2025
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Total hip arthroplasty; postoperative pain; PENG bloc; local anaesthetics infiltration
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: RC31/20/0227; 2020-A01887-32 (Other Identifier: ID-RCB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No