PENG+LFCN Block vs QIPB for Total Hip Arthroplasty

Comparison Between Quadro-iliac Plane Block (QIPB) and Pericapsular Nerve Group (PENG) Block Combined With Lateral Femoral Cutaneous Nerve Block for Total Hip Arthroplasty: a Randomized Controlled Trial

This randomized clinical trial aims to evaluate and compare the analgesic efficacy and functional outcomes of the quadro-iliac plane block (QIPB) and the pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve(LFCN) block in patients undergoing total hip arthroplasty. The primary outcome is the Numeric Rating Scale (NRS) within the first 48 hours after surgery. Secondary outcomes include postoperative total opioid consumption, ıncidence of quadriceps motor block, time to first ambulation, block performance time, falls, length of hospital stay, block- related complications(hematoma,local anesthetic systemic complications, vascular puncture, and infection), patient satisfaction assessed using a Likert scale, and incidence of postoperative nausea and vomiting.

Study Overview

• Status: Not yet recruiting
• Conditions: Pain Management; Pericapsular Nerve Group Block (PENG Block); Hip Arthroplasty, Total; Lateral Femoral Cutaneous Nerve Block; Quadro-Iliac Plane Block
• Intervention / Treatment: Procedure: Quadro iliac Plane Block(QİPB); Procedure: PENG Block and LFCN Blok; Procedure: Lateral femoral cutaneous nerve block(LFCN)

Detailed Description

Materials and Methods:

This prospective, randomized clinical trial will include patients aged 18-80 years with American Society of Anesthesiologists (ASA) physical status I-III who are scheduled to undergo elective unilateral primary total hip arthroplasty unde spinal anesthesia. Before enrollment, all patients will be informed about the study protocol and written informed consent will be obtained. Patients will be instructed on the use of the Numeric Rating Scale (NRS) for postoperative pain assessment, where 0 represents no pain and 10 represents the worst pain imaginable.

Patients with contraindications to spinal anesthesia, allergy to local anesthetics, coagulopathy, infection at the injection site, chronic opioid use, pre-existing neurological deficits involving the lower extremities, cognitive impairment preventing reliable communication, revision or bilateral hip arthroplasty, and refusal to participate will be excluded from the study.

Patients will be randomly allocated to one of two study groups using a computer-generated randomization sequence (https://www.randomizer.org). Randomization will be performed by a team member not involved in patient management or outcome assessment. Allocation concealment will be achieved using sequentially numbered sealed opaque envelopes, which will be opened immediately before block performance.

Upon arrival in the operating room, standard monitoring including electrocardiography, non-invasive blood pressure measurement, and pulse oximetry will be applied. Following intravenous access and preloading according to institutional practice, spinal anesthesia will be performed at the L3-L4 or L4-L5 intervertebral space using a 25-gauge Quincke spinal needle under aseptic conditions. After confirmation of free cerebrospinal fluid flow, 12-15 mg of 0.5% hyperbaric bupivacaine will be administered intrathecally. Supplemental sedation with intravenous midazolam and/or propofol may be provided when required for patient comfort.

Following successful spinal anesthesia, patients will receive either ultrasound-guided quadro-iliac plane block (QIPB) or ultrasound-guided pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve block according to group allocation. All blocks will be performed by anesthesiologists experienced in regional anesthesia and familiar with both techniques.

All patients will receive the same multimodal postoperative analgesic regimen and standardized postoperative rehabilitation protocol. Postoperative pain scores at rest and during movement will be assessed using the NRS during the first 48 postoperative hours. Opioid consumption, incidence of quadriceps motor block, time to first ambulation, patient satisfaction, postoperative nausea and vomiting, falls, length of hospital stay, block performance time, and block-related complications will also be recorded.

Outcome assessments will be performed by investigators who are unaware of group allocation.

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

Contacts and Locations

• Study Contact: Name: MUSTAFA KILIN, Consultant Anesthesiologists; Phone Number: +905464569218; Email: mustafa.kilin90@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age between 18 and 80 years
• American Society of Anesthesiologists physical status I-III
• Scheduled for elective unilateral primary total hip arthroplasty
• Surgery planned under spinal anesthesia
• Ability to understand and use the Numeric Rating Scale
• Written informed consent provided

Exclusion Criteria:

• Refusal to participate
• Revision total hip arthroplasty
• Bilateral total hip arthroplasty
• Contraindication to spinal anesthesia
• Contraindication to peripheral nerve block
• Known allergy to local anesthetics or study drugs
• Coagulopathy or anticoagulant use incompatible with neuraxial/regional anesthesia
• Infection at the block injection site
• Pre-existing neurological deficit involving the operative lower extremity
• Peripheral neuropathy
• Chronic opioid use
• Cognitive impairment or inability to communicate reliably
• Severe hepatic or renal failure
• Body mass index >35 kg/m²
• Pregnancy

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: quadro-iliac plane block (QIPB)	Procedure: Quadro iliac Plane Block(QİPB); Participants allocated to the QIPB group will receive an ultrasound-guided quadro-iliac plane block after spinal anesthesia. Following standard aseptic preparation, 30 mL of 0.25% bupivacaine will be administered into the target fascial plane under ultrasound guidance after confirming the absence of blood on aspiration.
Active Comparator: pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve block	Procedure: PENG Block and LFCN Blok; Participants in the PENG group will undergo an ultrasound-guided pericapsular nerve group (PENG) block after spinal anesthesia. A total of 20 mL of 0.25% bupivacaine will be administered.; Procedure: Lateral femoral cutaneous nerve block(LFCN); Participants in the LFCN group will undergo an ultrasound-guided lateral femoral cutaneous nerve block after spinal anesthesia. A total of 10 mL of 0.25% bupivacaine will be administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain scores	Postoperative pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores at rest will be recorded in the post-anesthesia care unit and at postoperative 6, 24, 36, and 48 hours. Pain scores during movement will be assessed during passive flexion of the operated hip at postoperative 6, 24, 36, and 48 hours.	Postoperative 6, 24, 36, and 48 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative opioid consumption	Total postoperative opioid consumption will be recorded and cumulative opioid consumption will be calculated at postoperative 24 and 48 hours.	Postoperative 24 and 48 hours
Incidence of quadriceps motor block	Quadriceps motor block will be assessed using knee extension testing and graded as: 0 = normal strength; = paresis; = paralysis. Motor block incidence will be defined as the presence of paresis or paralysis.	Postoperative 3, 6, and 24 hours
Patient satisfaction	Patient satisfaction with postoperative analgesia will be assessed using a Likert scale.	Postoperative 48 hours
Postoperative nausea and vomiting (PONV)	Incidence of postoperative nausea and vomiting during the first 48 postoperative hours.	Postoperative 48 hours
Falls	Incidence of falls during the first 48 postoperative hours.	Through postoperative day 2
Length of hospital stay	Number of days from surgery to hospital discharge.	Through hospital discharge, up to 30 days
Time to first ambulation	Time from the end of surgery to the first successful ambulation.	Postoperative day 1
Block performance time	Time from ultrasound probe placement to completion of local anesthetic injection.	Periprocedural
Block-related complications	Hematoma Vascular puncture Local anesthetic systemic toxicity (LAST) Infection at the injection site	Through hospital discharge, up to 30 days

Collaborators and Investigators

• Sponsor: Antalya City Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): November 15, 2026
• Primary Completion (Estimated): August 15, 2027
• Study Completion (Estimated): September 15, 2027

Study Registration Dates

• First Submitted: June 13, 2026
• First Submitted That Met QC Criteria: June 20, 2026
• First Posted (Actual): June 25, 2026

Study Record Updates

• Last Update Posted (Actual): June 25, 2026
• Last Update Submitted That Met QC Criteria: June 20, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: PENG; LFCN; QIPB
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: QİPBvsPENG+LFCN

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