PENG and LFCN Block Versus FIC Block for Multimodal Analgesia After Total Hip Replacement Surgery: a Retrospective Analysis Focused on Movement (Retro-PvF) (Retro-PvF)

Pericapsular Nerve Group (PENG) Block and Lateral Femoral Cutaneous Nerve (LFCN) Block Versus Fascia Iliaca (FIC) Block for Multimodal Analgesia After Total Hip Replacement Surgery: a Retrospective Analysis Focused on Movement (Retro- PvF)

Total hip arthroplasty is a major surgical procedure performed on a growing number of patients. Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and ambulation, thus expediting hospital discharge. Amongst the many peripheral nerve blocks, FIB (fascia iliaca block) has been recommended as the block of choice by many international guidelines since it offers the best pain control with a relatively low risk of motor block. PENG (pericapsular nerve group) and its association with LFCN (lateral femoral cutaneous nerve) has been proposed as an effective alternative that offers comparable, If not better, pain control with a considerably lower risk for motor block compared to FIB. Given the novelty of this block, there are few published papers on the subject, mostly case series or case reports thus justifying the need for retrospective study.

Study Overview

• Status: Not yet recruiting
• Conditions: Regional Anesthesia; Regional Anesthesia Block; Total Hip Replacement Surgery; Total Hip Arthroplasty \(THA\)
• Intervention / Treatment: Procedure: PENG + LFCN block; Procedure: FIC block

Detailed Description

The primary outcome was the degree of residual quadriceps femoris muscle paresis assessed with the MRC (medical research council) scale at 6 hours between PENG and LCFN. The secondary outcomes were NRS (numeric rating scale) at 6,12, 24 hours, total opioid consumption expressed as milligrams of morphine equivalents (MME), time to first rescue opioid and time to first postoperative ambulation.

• Study Type: Observational
• Enrollment (Estimated): 80

Contacts and Locations

• Study Contact: Name: Francesco Vetrone, MF; Phone Number: 8271 0039 025799; Email: francesco.vetrone@asst-nordmilano.it
• Study Contact Backup: Name: Angelo Pezzi, MD; Phone Number: 8293 0039 025799; Email: angelo.pezzi@asst-nordmilano.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Historical cohort study conducted among all patients who had THA from November 2022 to October 2023 at the ASST Nord Milano - Bassini Hospital, Cinisello Balsamo, Milano, Italy.

Description

Inclusion Criteria:

• elective total hip replacement surgery for non-traumatic hip disease,
• age over 18 years,
• complete clinical chart including type of peripheral nerve block performed,
• signed consent form for spinal anesthesia and peripheral nerve block.

Exclusion Criteria:

• preoperative opioid therapy,
• having received a peripheral nerve block other than PENG + LFCN or FICB,
• having received general anesthesia,
• incomplete chart,
• documented muscle weakness
• deviation from the established post-operative analgesia protocol.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
PENG + LFCN Block; group in which PENG + LFCN Block was performed	Procedure: PENG + LFCN block; The PENG block was performed under ultrasound guidance. After skin disinfection, the needle was advanced between the psoas tendon and pubic ramus where 20 mL of 0.5% ropivacaine were injected. The LFCN block was performed following the PENG block.10 ml of 0.5% ropivacaine were injected near the nerve into the fat-filled flat tunnel (FFFT) located at the level of the superior anterior iliac spine and lateral to the sartorius muscle.; Other Names: pericapsular nerve group block associated with lateral femoral cutaneous nerve block
FIC Block; group in which FIC Block was performed	Procedure: FIC block; FICB was performed under ultrasound guidance. The needle was advanced above the fascia iliaca and 20 mL of 0.5% ropivacaine were injected; Other Names: fascia iliaca compartment block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Movement of the lower limb affected by surgery	The Medical Research Council (MRC) Muscle Strength Scale (ranging scale from 0 to 5 0= no visible contraction, 5=normal power) was used to assess the degree of residual quadriceps femoris muscle paresis 6 hours postoperatively.	6 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	6 hours after surgery
pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	12 hours after surgery
pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	24 hours after surgery
Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	24 hours after surgery
Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	6 hours after surgery
Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	12 hours after surgery

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
time to first opioid request	we studied the effect of Regional anesthesia on opioid-sparing	From date of surgery until up to 3 days after
time to first postoperative ambulation	we studied the effect of Regional anesthesia on opioid-sparing	From date of surgery until up to 3 days after

Collaborators and Investigators

• Sponsor: Ospedale Edoardo Bassini

Study record dates

Study Major Dates

• Study Start (Estimated): March 26, 2024
• Primary Completion (Estimated): March 26, 2024
• Study Completion (Estimated): April 30, 2024

Study Registration Dates

• First Submitted: March 26, 2024
• First Submitted That Met QC Criteria: March 26, 2024
• First Posted (Actual): April 2, 2024

Study Record Updates

• Last Update Posted (Actual): April 4, 2024
• Last Update Submitted That Met QC Criteria: April 2, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: analgesia; THA; PENG; movement; Peripheral nerve blocks; fascia iliaca; total hip replacement surgery; LFCN
• Other Study ID Numbers: ID 4286

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
• product manufactured in and exported from the U.S.: No