Comparison of the Efficacy of Pericapsular Nerve Group Block Alone Versus Pericapsular Nerve Group Block Combined With Superior Cluneal and Superior Gluteal Nerve Blocks in Patients Undergoing Hip Surgery

Comparison of the Efficacy of Pericapsular Nerve Group Block Alone Versus Pericapsular Nerve Group Block Combined With Superior Cluneal and Superior Gluteal Nerve Blocks in Patients Undergoing Hip Surgery: A Prospective Randomized Clinical Study

In the clinic, total hip arthroplasty is a frequently performed surgical procedure that often results in moderate to severe postoperative pain. Multimodal analgesia approaches are commonly preferred for managing this pain, and in recent years, nerve blocks targeting pelvic innervation have become increasingly prominent. Among these, the Pericapsular Nerve Group (PENG) block has gained attention for providing effective analgesia by targeting the nerves responsible for the anterior innervation of the hip capsule. However, when used alone, the PENG block may be insufficient for controlling posterior hip pain and may not provide complete analgesia.

In this context, adding blocks targeting the superior cluneal nerve and the superior gluteal nerve-both of which contribute to the sensory innervation of the posterior hip region-has been proposed to enhance the analgesic effect when combined with the PENG block. Superior cluneal and superior gluteal nerve blocks have recently been described in anatomical and clinical studies, and by affecting the structures contributing sensory input to the posterior hip capsule, they hold significant potential for improving pain management.

In this study, the investigators aimed to evaluate the contribution of superior cluneal and superior gluteal nerve blocks, when added to the PENG block, to perioperative analgesia in patients undergoing total hip arthroplasty. The investigators sought to comparatively investigate whether this combination offers superior outcomes compared with the PENG block alone. It was hypothesized that combined nerve blocks may provide similar or improved recovery scores, lower pain scores, reduced opioid consumption, and enhanced analgesic efficacy without affecting the degree of motor blockade.

Study Overview

• Status: Enrolling by invitation
• Conditions: Hip Osteoarthritis; Osteonecrosis of the Femoral Head; Avascular Necrosis of Femur Head; Dysplasia of Hip Joint; Hip Surgeries
• Intervention / Treatment: Drug: 15 ml Bupivacaine Hcl 0.25% injection; Drug: 20 mL bupivacaine 0.25% injection

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

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Erzurum, Turkey (Türkiye)
    • Ataturk University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Voluntary participation in the study
• Age between 18 and 80 years
• ASA physical status I, II, or III
• Male or female patients

Exclusion Criteria:

• Refusal to participate in the study
• Allergy to the medications to be used
• History of severe cardiac, renal, or hepatic disease
• Presence of neurological deficits or neuropathy
• History of anticoagulant use
• Previous surgery in the inguinal or suprainguinal region
• Pregnancy
• Chronic opioid use at home
• History of spinal surgery

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: Application of PENG Block; Patients will be brought to the operating room one hour before surgery, and no premedication will be administered prior to their arrival. Before performing the PENG block, patients will be placed in the supine position. The ultrasound probe will be positioned in the transverse plane medial and caudal to the anterior superior iliac spine, and the anterior inferior iliac spine, iliopubic eminence, and psoas tendon will be identified. Using an in-plane technique, the needle will be advanced from lateral to medial and positioned between the psoas tendon and the periosteum. After negative aspiration, 15 mL of 0.25% bupivacaine will be administered.	Drug: 15 ml Bupivacaine Hcl 0.25% injection; For PENG Block, 15 mL of 0.25% bupivacaine will be administered.; Drug: 20 mL bupivacaine 0.25% injection; After performing PENG; 10 mL of 0.25% bupivacaine will be administered for each superior cluneal nerve block and superior gluteal nerve block
Active Comparator: Application of PENG Block together with Superior Cluneal and Superior Gluteal Nerve Blocks; All patients will receive a PENG block, and in addition: The superior cluneal nerve block will be performed at the level of the posterior iliac crest under ultrasound guidance, along the course of the nerve, using 10 mL of 0.25% bupivacaine. The superior gluteal nerve block will be administered in the lateral decubitus position under ultrasound guidance, with 10 mL of 0.25% bupivacaine injected between the gluteal muscles along the trajectory of the nerve.	Drug: 20 mL bupivacaine 0.25% injection; After performing PENG; 10 mL of 0.25% bupivacaine will be administered for each superior cluneal nerve block and superior gluteal nerve block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
QoR-15 (Quality of Recovery-15) questionnaire	The primary outcome measure will be the QoR-15 (Quality of Recovery-15) questionnaire administered at the 24th postoperative hour. QoR-15 is a validated 15-item short survey assessing patients' postoperative physical comfort, emotional state, level of independence, pain control, and overall well-being. The total score obtained will be used to compare the overall quality of recovery between groups. The same questionnaire will be repeated at the 48th postoperative hour.	24th and 48th postoperative hour

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps Motor Block Assessment	Motor block will be assessed using the following 3-point scale: 0 = Normal strength (dorsiflexion against gravity and resistance); = Paresis (dorsiflexion against gravity only, not against resistance); = Paralysis (dorsiflexion not possible)	It will be assessed at the 4th, 8th, 12th, and 24th postoperative hours.
Motor Block Assessment at the Tibialis Anterior Muscle for the Sciatic Nerve	Motor block will be assessed using the following 3-point scale: 0 = Normal strength (dorsiflexion against gravity and resistance); = Paresis (dorsiflexion against gravity only, not against resistance); = Paralysis (dorsiflexion not possible)	It will be assessed at the 4th, 8th, 12th, and 24th postoperative hours.
Fentanyl consumption	Fentanyl consumption will be recorded via the PCA device during the postoperative intervals of 0-4, 4-8, and 8-24 hours. Total opioid consumption will be calculated at the 24th postoperative hour.	The first 24 postoperative hours
VAS pain scores	VAS pain scores will be assessed at the 1st, 2nd, 4th, 8th, 12th, and 24th postoperative hours, both at rest and during movement. The region where the patient experiences the most intense pain will be recorded as either the anterior or posterior hip.	The first 24 postoperative hours

Collaborators and Investigators

• Sponsor: Ataturk University

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2025
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: November 16, 2025
• First Submitted That Met QC Criteria: November 20, 2025
• First Posted (Estimated): December 1, 2025

Study Record Updates

• Last Update Posted (Actual): December 8, 2025
• Last Update Submitted That Met QC Criteria: December 2, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Pathologic Processes; Arthritis; Joint Diseases; Rheumatic Diseases; Necrosis; Osteoarthritis; Osteonecrosis; Pathological Conditions, Signs and Symptoms; Osteoarthritis, Hip; Legg-Calve-Perthes Disease; Femur Head Necrosis; Organic Chemicals; Therapeutics; Drug Administration Routes; Drug Therapy; Anilides; Amides; Aniline Compounds; Amines; Bupivacaine; Injections
• Other Study ID Numbers: PENGHip

Drug and device information, study documents

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