PENG vs. QLB vs. Lumbar ESPB in Total Hip Surgery

Comparison of Pericapsular Nerve Group Block, Quadratus Lumborum Block and Lumbar Erector Spinae Plane Block for Acute Pain Management in Total Hip Surgery: A Randomized Clinical Trial

The aim of this study is to compare between Pericapsular Nerve Group Block, Erector Spinae Plane Block and Quadratus Lumborum Block for managing acute postoperative pain in patients undergoing total hip surgeries under spinal anesthesia.

Study Overview

• Status: Recruiting
• Conditions: Total Hip Surgery; Pericapsular Nerve; Quadratus Lumborum; ESPB
• Intervention / Treatment: Procedure: PENG block Technique; Procedure: Lumbar ESPB Technique; Procedure: Transmuscular QLB-t block Technique

Detailed Description

Total hip surgeries are one of the most common major orthopedic procedures to improve patient's functional status and quality of life. However, despite these advantages, the immediate postoperative period can be associated with severe pain that delays mobilization and increases hospital stay and the risk of thromboembolic events.

Various methods are used for postoperative pain management. Intravenous opioid agents are among them, but they may cause undesirable side effects, such as respiratory depression, sedation, constipation, allergic reaction, nausea, and vomiting. Thus, alternative techniques are preferred.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mohammad F. Algyar, MD; Phone Number: +20 111645345; Email: mohammad.algaiar@med.kfs.edu.eg

Study Locations

• Egypt
  • ElGharbiaa
    • Tanta, ElGharbiaa, Egypt, 31511
      • Recruiting
      • Mohammad Fouad Algyar
      • Contact: Mohammad F Algyar, MD; Phone Number: 00201111645345; Email: mohammad.algaiar@med.kfs.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18-65 years
• Both genders
• Body mass index < 40 kg/m^2
• American Society of Anesthesiologists (ASA) physical status I-III
• Posted for total hip surgeries under spinal anesthesia

Exclusion Criteria:

• The presence of contraindications or allergy to local anesthetic agents
• Chronic use of opioids or corticosteroids
• Infection at the puncture site
• Coagulopathy
• Psychiatric disorders (dementia or cognitive impairment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PENG block Technique; Patients will receive ultrasound-guided Pericapsular Nerve Group Block using 30 ml bupivacaine 0.25%.	Procedure: PENG block Technique; A linear probe will be used. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, 30 ml of bupivacaine 0.25% will be injected in the plane beneath the iliopsoas muscle
Experimental: Lumbar ESPB Technique; Patients will receive lumbar erector spinae plane block using 30 ml bupivacaine 0.25%	Procedure: Lumbar ESPB Technique; Using the out-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthetic solution, 30 ml bupivacaine 0.25% will be administered leading to hydrodissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurs when administering local anesthetic . All local anesthetic will be administered to this location between the transverse process and the erector spinae muscle
Experimental: Transmuscular QLB-t block Technique; Patients will receive transmuscular quadratus lumborum block using 30 ml bupivacaine 0.25%	Procedure: Transmuscular QLB-t block Technique; A convex transducer will be placed in the transverse plane on the flank of the patient cranial to the iliac crest. The 4th lumbar vertebral transverse process, erector spinae muscles, psoas muscle, transverse abdominis muscle, internal and externa oblique muscles, and the quadratus lumborum muscle will be identified. A 15 cm 22G insulated needle will be inserted on the posterior corner of the transducer. 30 ml bupivacaine 0.25% will be administered between the quadratus lumborum and psoas muscles into the fascial plane.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total amount of rescue analgesia	Total amount of rescue analgesia in the form of morphine will be recorded	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
First analgesic request	The time to first request of rescue analgesia will be recorded	24 hours Postoperatively
Pain level	Pain level will be evaluated using numeric rating analogue scale (NRS), which ranges from 0 to 10 points, with 0 indicating no pain, 1-3 indicating mild pain, 4-6 indicating moderate pain, and 7-10 indicating severe pain.	48 hours Postoperatively
Adverse events	Adverse events will be recorded (e.g., nausea, vomiting, hypotension and bradycardia)	48 hours Postoperatively

Collaborators and Investigators

• Sponsor: Kafrelsheikh University

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2022
• Primary Completion (Estimated): October 10, 2023
• Study Completion (Estimated): October 10, 2023

Study Registration Dates

• First Submitted: October 26, 2022
• First Submitted That Met QC Criteria: October 26, 2022
• First Posted (Actual): October 31, 2022

Study Record Updates

• Last Update Posted (Actual): September 6, 2023
• Last Update Submitted That Met QC Criteria: September 3, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: MKSU 50-9-21

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available under a reasonable request from the corresponding author.
• IPD Sharing Time Frame: One year after the end of the study
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

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