The Ultrasound Guided Pericapsular Nerve Group and Anterior Quadratus Lumborum Blocks in Hip Replacement Surgeries

Comparison Between the Ultrasound Guided Pericapsular Nerve Group Block and Anterior Quadratus Lumborum Block in Elderly Patients Undergoing Total Hip Replacement Surgeries: A Randomized Controlled Clinical Trial

The investigators hypothesis that PENG block will produce effective opioid sparing analgesia with enhanced motor recovery more than AQLB in elderly patients undergoing total hip replacement surgeries

Study Overview

• Status: Completed
• Conditions: Post Operative Analgesia
• Intervention / Treatment: Procedure: Anterior quadratus lumborum block technique (AQLB); Procedure: Pericapsular Nerve Group (PENG) block; Drug: Control Group

Detailed Description

Aim of the work:

The aim of this study is to compare analgesic efficacy and motor recovery of the ultrasound guided anterior quadratus lumborum block and the pericapsular nerve group block

Statistical Analysis:

Data will be coded and entered using the statistical package SPSS version 22. Categorical data will be expressed frequency and proportion and will be compared by Chi2. Numerical data will be summarized using mean and standard deviation. Comparisons between groups for normally distributed data will be done using analysis of variance (ANOVA), while for non-normally distributed numeric variable will be done by Krauskal Wallis test. P value less than or equal to 0.05 will be considered statistically significant. All test will be two tailed

• Study Type: Interventional
• Enrollment (Actual): 93
• Phase: Phase 4

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Faculty of Medicine, Cairo University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Both genders
• Type of surgery; unilateral elective total hip replacement.
• Physical status ASA I- III
• Age ≥ 65 Years.
• Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.
• Traumatic fracture hip through anterolateral approach.

Exclusion Criteria:

• Patient refusal.
• Patients with known sensitivity or contraindication to drugs used in the study (local anesthetics & opioids).
• History of psychological disorders and/or chronic pain.
• Pre- existing peripheral neuropathies
• Coagulopathy.
• Infection of the skin at the site of needle puncture area.
• Active cardiac condition (unstable coronary syndromes, significant arrhythmias, severe valvular disease).
• Acute respiratory disease (active chest infection, respiratory failure).
• Advanced liver disease (increased liver enzymes >3 folds) or severe kidney disease (creatinine >2).
• long operative time more than 3 hours.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Anterior quadratus lumborum block technique (AQLB); AQLB performed in the lateral position. A low-frequency convex probe for the abdomen (2-5) MHz convex probe, (Siemens ACUSON X300 Ultrasound System) was placed horizontally above the iliac crest. On ultrasound, The psoas major was located on the ventral side of the transverse process, the erector spinae was located on the dorsal side of the transverse process, and the quadratus lumborum was located on the lateral side of the transverse process. A 38-mm 22-gauge regional block needle was advanced in-plane from posterior to anterior directing the needle tip in the fascial plane between the psoas major and the quadratus lumborum that was confirmed by injecting 1 ml saline and watchingt the fluil fting the muscle while not distending any of the two muscles (hydro-localization). Then 30mL of local anaesthetic (29ml of 0.25% bupivacaine + 1 ml of dexamethasone (4mgs) was injected with observation of local anaesthesia spread in the fascial plane.	Procedure: Anterior quadratus lumborum block technique (AQLB); AQLB performed in the lateral position. A low-frequency convex probe for the abdomen (2-5) MHz convex probe, (Siemens ACUSON X300 Ultrasound System) was placed horizontally above the iliac crest. On ultrasound, The psoas major was located on the ventral side of the transverse process, the erector spinae was located on the dorsal side of the transverse process, and the quadratus lumborum was located on the lateral side of the transverse process. A 38-mm 22-gauge regional block needle was advanced in-plane from posterior to anterior directing the needle tip in the fascial plane between the psoas major and the quadratus lumborum that was confirmed by injecting 1 ml saline and watchingt the fluil fting the muscle while not distending any of the two muscles (hydro-localization). Then 30mL of local anaesthetic (29ml of 0.25% bupivacaine + 1 ml of dexamethasone (4mgs) was injected with observation of local anaesthesia spread in the fascial plane.
Active Comparator: Pericapsular Nerve Group (PENG) block; With the patients in supine position, A low-frequency convex probe (2-5 MHz) in was placed in a transverse plane over the anterior inferior iliac spine and then it was rotated 45 degrees in counter-clockwise direction to be aligned with the pubic ramus. In this view, the ilio-pubic eminence, iliopsoas muscle tendon, femoral nerve and vessels was observed. With in-plane approach, a 38-mm 22-gauge (22-G, 50-mm) regional block needle inserted in-plane, from lateral to medial to place the needle tip underneath the iliopsoas tendon, exactly between the ilipsoas fascia anteriorly and the pubic ramus posteriorly. Following negative resistance and aspiration tests, correct location of the needle tip was confirmed by injecting 1 ml saline. Then, 30mL of local anaesthetic (29ml of 0.25% bupivacaine+ 1ml of dexamethasone (4mgs) was injected while observing for adequate fluid spread.	Procedure: Pericapsular Nerve Group (PENG) block; With the patients in supine position, A low-frequency convex probe (2-5 MHz) in was placed in a transverse plane over the anterior inferior iliac spine and then it was rotated 45 degrees in counter-clockwise direction to be aligned with the pubic ramus. In this view, the ilio-pubic eminence, iliopsoas muscle tendon, femoral nerve and vessels was observed. With in-plane approach, a 38-mm 22-gauge (22-G, 50-mm) regional block needle inserted in-plane, from lateral to medial to place the needle tip underneath the iliopsoas tendon, exactly between the ilipsoas fascia anteriorly and the pubic ramus posteriorly. Following negative resistance and aspiration tests, correct location of the needle tip was confirmed by injecting 1 ml saline. Then, 30mL of local anaesthetic (29ml of 0.25% bupivacaine+ 1ml of dexamethasone (4mgs) was injected while observing for adequate fluid spread.
Active Comparator: Control Group; Pataints received opioid analgesia with GA	Drug: Control Group; Pataints received opioid analgesia with genaral anesthesia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Total Amount of Morphine Consumption	Total dose of IV morphine (mg) administered as rescue analgesia during the first 24 postoperative hours. Morphine 0.05 mg/kg IV boluses were given when NRS ≥4, up to a maximum of 0.3 mg/kg/24 h. Reported as median (IQR).	Immediatly post operative for 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale at Rest Over First 24 Hours	Pain intensity at rest using 0-10 Numeric Pain Rating Scale (0 = no pain, 10 = worst imaginable pain) measured at specified time points; data reported as median (IQR).	30 minutes, 2, 4, 6, 8, 12, 18, and 24 hours after surgery
Numeric Pain Rating Scale During Passive 90° Hip Flexion Over First 24 Hours	Pain intensity during passive 90° hip flexion using 0-10 NRS at same time points; reported as median (IQR).	at 30 minutes, 2, 4, 6, 8, 12, 18 and 24 hours postoperatively
Time to First Rescue Morphine Analgesia	Time from arrival in PACU to first administration of IV morphine rescue dose (NRS ≥4). Reported as median (IQR).	Immediatly post operative for 24 hours
Manual Muscle Test (MMT) Score for Quadriceps/Iliopsoas Over First 24 Hours	Manual muscle test (0-5 scale; 0 = no contraction, 5 = full ROM against gravity and maximal resistance) for quadriceps and iliopsoas muscles on the operated side, after extubation, at predefined time points.	30 minutes, 2, 4, 6, 8, 12, 18 and 24 hours postoperatively
Active Hip Flexion Range of Motion (0°-90°) Over First 24 Hours	Active hip flexion range of motion (degrees) of the operated hip, from 0° to 90°, assessed at same time points as MMTe. Reported as median (IQR).	30 minutes, 2, 4, 6, 8, 12, 18 and 24 hours postoperatively
Total Intraoperative Fentanyl Dose	Total dose of IV fentanyl administered intraoperatively. Additional boluses of 1 μg/kg were given if MAP or HR increased by >20% above baseline. Reported as mean ± SD.	During surgery
Time to First Walk	Time from end of surgery to first ambulation (≥3 steps with walker). Reported as median (IQR)	From end of surgery until first walk (within postoperative 24 h)
Length of Hospital Stay	Time from surgery to hospital discharge. Reported as mean ± SD.	From date of surgery until discharge

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Mohamed A Ollaek, MD, Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2022
• Primary Completion (Actual): September 15, 2023
• Study Completion (Actual): January 31, 2024

Study Registration Dates

• First Submitted: November 5, 2024
• First Submitted That Met QC Criteria: November 6, 2024
• First Posted (Actual): November 7, 2024

Study Record Updates

• Last Update Posted (Actual): January 30, 2026
• Last Update Submitted That Met QC Criteria: January 29, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Digestive System and Oral Physiological Phenomena; Dentistry; Dental Physiological Phenomena; Control Groups; Dental Occlusion
• Other Study ID Numbers: MD-16-2022

Drug and device information, study documents

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