PENG Block With or Without PPD Block for Postoperative Analgesia After Total Hip Arthroplasty

Comparison of the Efficacy of Pericapsular Nerve Group (PENG) Block Versus PENG Block Added to Posterior Pericapsular Deep Gluteal (PPD) Block for Postoperative Analgesia in Total Hip Arthroplasty

This single-center, prospective, randomized controlled clinical trial aims to compare the postoperative analgesic efficacy of PENG block with or without posterior pericapsular deep gluteal block in adult patients undergoing elective primary total hip arthroplasty under spinal anesthesia. Total hip arthroplasty is commonly associated with moderate to severe postoperative pain. Although PENG block provides analgesia for the anterior hip capsule, some patients may still experience pain originating from the posterior capsule. The addition of PPD block may improve analgesia by targeting posterior articular branches. Participants will be randomized into two groups: one group will receive PENG block, and the other group will receive PENG plus PPD block. Postoperative pain will be assessed using the Numeric Rating Scale (NRS). The study will compare postoperative pain scores and other analgesia-related outcomes between groups.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Total Hip Arthroplasty (THA)
• Intervention / Treatment: Procedure: PENG Block; Procedure: Deep posterior gluteal compartment block

Detailed Description

This study is planned as a single-center, prospective, randomized, controlled, double-blind trial in adult patients undergoing elective primary total hip arthroplasty under spinal anesthesia. Eligible participants will be patients aged 18 years or older, classified as ASA physical status I-III, and able to provide informed consent. Patients with ASA IV-V, serious cardiac, respiratory, hepatic, or renal disease, neuropsychiatric disorders, cognitive impairment preventing reliable NRS assessment, coagulopathy, local anesthetic allergy, infection or scar at the block site, failed block, signs of local anesthetic systemic toxicity, exposure to local anesthetic doses above protocol limits, revision total hip arthroplasty, fracture-related total hip arthroplasty, or refusal to participate will be excluded. Participants will be randomized by sealed-envelope method into two groups. Group 1 will receive PENG block after spinal anesthesia in the supine position using ultrasound guidance and 20 mL of 0.25% bupivacaine. Group 2 will receive PENG block followed by ultrasound-guided PPD block, with 30 mL of 0.25% bupivacaine used for the PPD block. In addition, both groups will receive lateral femoral cutaneous nerve block with 5 mL of 0.25% bupivacaine. The primary objective is to compare postoperative pain intensity between groups using Numeric Rating Scale scores. Secondary evaluations include postoperative analgesic consumption, time to first rescue analgesia, time to first mobilization, and motor function including ankle dorsiflexion strength. An initial pilot phase including 40 patients is planned, and the final sample size will be calculated using G*Power based on pilot data with alpha 0.05 and power 0.80. The study will continue until the target sample size is reached.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Guzin Ceran Assistant Professor, MD; Phone Number: +90-506-163-0936; Email: gzncrn@hotmail.com
• Study Contact Backup: Name: Abdulkadir Apaydin, MD; Phone Number: +90-531-951-2333; Email: apydnkadir@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 18 years and older
• American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled for elective primary total hip arthroplasty under spinal anesthesia
• Able to provide written informed consent

Exclusion Criteria:

• ASA physical status IV or V
• Serious concomitant cardiac, respiratory, hepatic, or renal disease
• Known neuropsychiatric disorder
• Cognitive impairment preventing understanding or response to the Numeric Rating Scale (NRS)
• Coagulopathy
• Local anesthetic allergy
• Infection or scar at the block site
• Failed block
• Refusal to participate
• Signs of local anesthetic systemic toxicity after block
• Patients in the PENG plus PPD group who would be exposed to a total local anesthetic dose above 3 mg/kg in patients weighing less than 50 kg
• Revision total hip arthroplasty
• Total hip arthroplasty planned for fracture

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: PENG Block; Participants in this arm will receive ultrasound-guided PENG block after spinal anesthesia for postoperative analgesia during primary total hip arthroplasty. In addition, lateral femoral cutaneous nerve block will be performed.	Procedure: PENG Block; Ultrasound-guided pericapsular nerve group block performed after spinal anesthesia for postoperative analgesia in patients undergoing primary total hip arthroplasty. In Group 1, PENG block will be performed in the supine position using an in-plane technique, and 20 mL of 0.25% bupivacaine will be injected between the psoas tendon and iliopubic ramus. In both groups, lateral femoral cutaneous nerve block will also be performed as part of the analgesic protocol.; Other Names: Pericapsular Nerve Group Block
Active Comparator: PENG Plus PPD Block; Participants in this arm will receive ultrasound-guided PENG block followed by ultrasound-guided posterior pericapsular deep gluteal block after spinal anesthesia for postoperative analgesia during primary total hip arthroplasty. In addition, lateral femoral cutaneous nerve block will be performed.	Procedure: PENG Block; Ultrasound-guided pericapsular nerve group block performed after spinal anesthesia for postoperative analgesia in patients undergoing primary total hip arthroplasty. In Group 1, PENG block will be performed in the supine position using an in-plane technique, and 20 mL of 0.25% bupivacaine will be injected between the psoas tendon and iliopubic ramus. In both groups, lateral femoral cutaneous nerve block will also be performed as part of the analgesic protocol.; Other Names: Pericapsular Nerve Group Block; Procedure: Deep posterior gluteal compartment block; Ultrasound-guided posterior pericapsular deep gluteal block performed after PENG block and spinal anesthesia for postoperative analgesia in patients undergoing primary total hip arthroplasty. In Group 2, the block will be performed in the lateral decubitus position with the hip and knee flexed to 90 degrees, and 30 mL of 0.25% bupivacaine will be injected after needle placement to the posterior acetabular rim near the ischiofemoral ligament using an in-plane technique.; Other Names: PPD block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity at 6 hours measured by Numeric Rating Scale (NRS)	Postoperative pain intensity will be assessed using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. The primary comparison between groups will be the NRS score at postoperative 6 hours	6 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity over the first 24 hours measured by Numeric Rating Scale (NRS)	Postoperative pain intensity will also be assessed in the recovery room and at postoperative 2, 12, and 24 hours using the Numeric Rating Scale (NRS)	Recovery room, 2 hours, 12 hours, and 24 hours after surgery
Total analgesic consumption during the first 24 hours	Total amount of analgesic medication consumed within the first 24 hours after surgery will be recorded and compared between groups	24 hours after surgery
Time to first rescue analgesic requirement	Time from block performance to first additional analgesic requirement will be recorded	Up to 24 hours after surgery
Time to first mobilization	Time to first standing or mobilization after surgery will be recorded and compared between groups	Up to 24 hours after surgery
Ankle dorsiflexion motor strength	Ankle dorsiflexion motor strength will be assessed postoperatively to evaluate possible motor weakness related to block spread.	Recovery room, 2 hours, 6 hours, 12 hours, and 24 hours after surgery

Collaborators and Investigators

• Sponsor: Kirsehir Ahi Evran Universitesi
• Investigators: Principal Investigator: Guzin Ceran, MD, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): April 5, 2026
• Primary Completion (Estimated): April 5, 2027
• Study Completion (Estimated): June 5, 2027

Study Registration Dates

• First Submitted: March 25, 2026
• First Submitted That Met QC Criteria: March 25, 2026
• First Posted (Actual): March 30, 2026

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative analgesia; PENG block; Numeric Rating Scale; PPD block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: KAEAH-THA-PENG-PPD-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to share individual participant data with other researchers

Drug and device information, study documents

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