Comparison of Pericapsular Nerve Group Block and Quadratus Lumborum Block

Comparison of Pericapsular Nerve Group Block with Lateral Femoral Cutaneous Nerve Block and Quadratus Lumborum Block for Total Hip Arthroplasty

Adequate pain management following total hip arthroplasty (THA) is a key component for patient satisfaction and early ambulation. However, due to the complexity of the innervation of the hip joint, the most appropriate anaesthetic and analgesic technique for THA remains unclear. A femoral nerve block is commonly performed and well established but is associated with motor weakness. Recently, the pericapsular nerve group (PENG) block has been introduced as an effective choice which targets the articular branches of the hip. The quadratus lumborum block (QLB) is a relatively new regional block that has been reported to provide effective analgesia for THA.

The main objective of this study is to compare the effectiveness of the ultrasound-guided PENG block technique compared to QLB block in terms of efficacy of pain control and the safety profile after total hip arthroplasty under spinal anesthesia.

Study Overview

• Status: Completed
• Conditions: Total Hip Surgery; Pericapsular Nerve; Quadratus Lumborum
• Intervention / Treatment: Drug: PENG/LFCN and QL Blocks

Detailed Description

The patients will be randomly classified into two equal groups (40 patients each). Group allocation will be done by computer generated random numbers and closed opaque sealed envelopes. The study will be designed to be double blind as all patients and outcomes assessor will be blinded to group assignment.

Patients will be randomized to one of three equal groups:

Group I (n= 40 patients): Patients in this group will receive an ipsilateral single shot of QLB (30 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

Group II(n= 40 patients): patients in this group will receive an ipsilateral single-shot of PENG block (25 ml of plain bupivacaine 0.25%) and LFCN block (5 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Konya, Turkey
    • Alper Kilicaslan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 36 years to 81 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Physical status according to American Society of Anesthesiologists (ASA ) I-III

Exclusion Criteria:

• Younger than 40 years old and older than 85
• Patients undergoing general anesthesia
• Allergy or intolerance to one of the study medications
• Infection of the skin at the site of the needle puncture,
• Patients who do not accept the procedure
• History of bleeding diathesis
• ASA IV,
• Chronic gabapentin/pregabalin,opioid use
• Hepatic or renal insufficiency
• Previous operation on the same hip
• BMI >40

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group QL Block; A convex transducer will be placed in the transverse plane on the flank cranial to the iliac crest to visualise the transverse process of the 4th lumbar vertebra, erector spina, quadratus lumborum and psoas muscles as a 'Shamrock sign'. The needle will inserted in to the fascial plane between the quadratus lumborum and psoas muscles and 30 ml bupivacaine 0.25% will be administered.	Drug: PENG/LFCN and QL Blocks; Bupivacaine 0.25% injection
Active Comparator: Group PENG+LFCN Block; A linear probe will be placed on the anterior inferior iliac crest in the transverse plane while the patient is in the supine position. After rotating 45 degrees, the pubic ramus, femoral artery and psoas muscle will be visualized. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and the iliopubic eminence After a negative aspiration test, 25 ml bupivacaine 0.25% will be injected. Then, the lateral femoral cutaneous nerve (LFCN) block was performed using linear US probe (10-18 MHz).The LFCN will be localized, infero-medially to the antero-superior iliac spine, laterally to the sartorius muscle and 5 ml of bupivacaine 0.25% will be carefully injected.	Drug: PENG/LFCN and QL Blocks; Bupivacaine 0.25% injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain scores	Numerical Rating Scale-NRS (0 = no pain and 10 = worst imaginable painranged from 0 to 10)	Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours
Opioid consumption	Mean opioid consumption in morphine equivalents	Changes from baseline opioid consumption at postoperative 0, 2, 6, 12 and 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps muscle strength	Quadriceps motor function will be tested with the patient supine and with the hip and knee flexed at 45º and 90º, respectively	Postoperative 24 hours period
Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depression	Presence of postoperative nausea, vomiting, pruritus, urinary retention, respiratory depressio	Postoperative 24 hours period
Patient satisfaction	Patients asked whether they would choose the same anaesthetic management in a future operation: Yes/No	Postoperative 24 hours period

Collaborators and Investigators

• Sponsor: Konya Necmettin Erbakan Üniversitesi

Publications and helpful links

General Publications

• Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.
• Hussain N, Brull R, Speer J, Hu LQ, Sawyer T, McCartney CJL, Abdallah FW. Analgesic benefits of the quadratus lumborum block in total hip arthroplasty: a systematic review and meta-analysis. Anaesthesia. 2022 Oct;77(10):1152-1162. doi: 10.1111/anae.15823. Epub 2022 Aug 10.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2022
• Primary Completion (Actual): April 10, 2023
• Study Completion (Actual): April 21, 2023

Study Registration Dates

• First Submitted: November 30, 2022
• First Submitted That Met QC Criteria: December 8, 2022
• First Posted (Actual): December 16, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 17, 2024
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: PENG block; QLB; Total Hip Surgery
• Other Study ID Numbers: 2021-541

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No