Autonomic and Immune Effects of Regional Anesthesia in Total Hip Arthroplasty (PENG neuromodu)
Effects of Three Regional Anesthesia Strategies on Autonomic Regulation, Systemic Inflammatory Response, and Postoperative Recovery Following Elective Total Hip Arthroplasty: A Prospective Randomized Double-Blind Trial
Surgical trauma activates the sympathetic nervous system and induces a systemic inflammatory response, both of which may adversely affect postoperative recovery. Regional anesthesia has traditionally been used for perioperative analgesia; however, emerging evidence suggests that peripheral nerve blocks may also modulate autonomic and immune pathways. This prospective randomized double-blind trial aims to compare three regional anesthesia strategies in patients undergoing elective total hip arthroplasty under spinal anesthesia and to determine their effects on autonomic regulation, systemic inflammatory response, postoperative pain, opioid consumption, quality of recovery, and early functional outcomes.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Total hip arthroplasty (THA) is associated with substantial surgical trauma, resulting in activation of the sympathetic nervous system and a systemic inflammatory response that may contribute to postoperative pain, delayed functional recovery, and perioperative complications. Although regional anesthesia techniques are widely used to improve postoperative analgesia, increasing evidence suggests that they may also influence autonomic regulation and neuroimmune interactions beyond their analgesic effects. The extent to which different regional anesthesia strategies modify perioperative autonomic and inflammatory responses remains incompletely understood.
This prospective, randomized, double-blind, controlled trial aims to compare three regional analgesic strategies in patients undergoing elective primary total hip arthroplasty under spinal anesthesia: ultrasound-guided pericapsular nerve group (PENG) block, local infiltration analgesia (LIA), and the combination of PENG block with LIA. All patients will receive standardized perioperative anesthetic and multimodal analgesic management, with the regional analgesic technique being the only study intervention.
The primary objective is to determine whether different regional anesthesia strategies differentially influence perioperative autonomic regulation and systemic inflammatory response. Autonomic function will be assessed using perioperative hemodynamic parameters and vasopressor requirements, while systemic inflammatory activation will be evaluated using routinely available inflammatory biomarkers, including the Systemic Immune-Inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and other laboratory markers measured before and after surgery.
Secondary objectives include comparison of postoperative pain intensity at rest and during movement, opioid consumption, time to first rescue analgesia, quality of recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire, incidence of postoperative nausea and vomiting, time to first ambulation, length of hospital stay, patient satisfaction, and the incidence of postoperative complications.
The study is designed to determine whether combining peripheral nerve blockade with periarticular infiltration provides additive benefits not only for postoperative analgesia but also for modulation of autonomic-immune interactions and enhancement of postoperative recovery. The findings may improve understanding of peripheral nerve blocks as a form of perioperative neuromodulation and support optimization of regional anesthesia strategies in patients undergoing total hip arthroplasty.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Malgorzata Reysner, MD PhD
- Numéro de téléphone: +48 61 8310122
- E-mail: mreysner@ump.edu.pl
Lieux d'étude
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Poznan, Pologne, 62-701
- Poznan University of Medical Sciences
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Adults aged ≥18 years.
- Scheduled for elective primary total hip arthroplasty due to primary hip osteoarthritis.
- American Society of Anesthesiologists (ASA) physical status I-III.
- Planned spinal anesthesia with one of the study regional analgesia techniques.
- Ability to understand the study procedures and provide written informed consent.
Exclusion Criteria:
- Refusal or inability to provide written informed consent.
- Revision hip arthroplasty, simultaneous bilateral hip arthroplasty, or hip arthroplasty performed for an acute fracture.
- Known hypersensitivity to ropivacaine or other medications required for the study procedures.
- Contraindication to spinal anesthesia, PENG block, or local infiltration analgesia, including infection at the injection site or a coagulation disorder or antithrombotic treatment that precludes safe performance of the planned procedures.
- Pre-existing neurological or neuromuscular disease that substantially affects sensation or motor function in the operated limb or prevents reliable assessment of study outcomes.
- Cognitive impairment or a communication disorder that prevents understanding of the study procedures or reliable completion of pain assessments.
- A medical condition that, in the investigator's judgment, makes participation or the planned anesthetic procedures unsafe.
- Planned use of an additional regional analgesic technique outside the study protocol.
- Participation in another interventional study that could interfere with the assessment of the study outcomes.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: PENG Block
Ropivacaine for Pericapsular Nerve Group (PENG) Block |
Ultrasound-guided single-injection pericapsular nerve group (PENG) block performed before surgery using 20ml of 0.2% ropivacaine
Autres noms:
|
|
Expérimental: Local Infiltration Analgesia (LIA)
Ropivacaine for Local Infiltration Analgesia |
Local infiltration analgesia is performed intraoperatively - 20ml 0.2% ropivacaine
Autres noms:
|
|
Expérimental: Combined PENG Block + LIA
Ropivacaine for Pericapsular Nerve Group (PENG) block before surgery and Local Infiltration Analgesia (LIA) |
Ultrasound-guided single-injection pericapsular nerve group (PENG) block performed before surgery using 20ml of 0.2% ropivacaine
Autres noms:
Local infiltration analgesia is performed intraoperatively - 20ml 0.2% ropivacaine
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change in Systemic Immune-Inflammation Index (SII)
Délai: 24 hours after surgery
|
Comparison of the change in Systemic Immune-Inflammation Index from baseline to postoperative 24 hours among the three study groups. |
24 hours after surgery
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Neutrophil-to-Lymphocyte Ratio (NLR)
Délai: 24 hours after surgery
|
Comparison of the change in neutrophil-to-lymphocyte ratio among the three study groups. |
24 hours after surgery
|
|
Neutrophil-to-Lymphocyte Ratio (NLR)
Délai: 12 hours after surgery
|
Comparison of the change in neutrophil-to-lymphocyte ratio among the three study groups. |
12 hours after surgery
|
|
Neutrophil-to-Lymphocyte Ratio (NLR)
Délai: 48 hours after surgery
|
Comparison of the change in neutrophil-to-lymphocyte ratio among the three study groups. |
48 hours after surgery
|
|
Platelet-to-Lymphocyte Ratio (PLR)
Délai: 24 hours after surgery
|
Comparison of the change in platelet-to-lymphocyte ratio among the three study groups. |
24 hours after surgery
|
|
Platelet-to-Lymphocyte Ratio (PLR)
Délai: 48 hours after surgery
|
Comparison of the change in platelet-to-lymphocyte ratio among the three study groups. |
48 hours after surgery
|
|
Platelet-to-Lymphocyte Ratio (PLR)
Délai: 12 hours after surgery
|
Comparison of the change in platelet-to-lymphocyte ratio among the three study groups. |
12 hours after surgery
|
|
Postoperative pain intensity
Délai: 2 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at rest. |
2 hours after surgery
|
|
Postoperative pain intensity at movement
Délai: 2 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at movement. |
2 hours after surgery
|
|
Postoperative pain intensity at movement
Délai: 6 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at movement. |
6 hours after surgery
|
|
Postoperative pain intensity at movement
Délai: 12 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at movement. |
12 hours after surgery
|
|
Postoperative pain intensity at movement
Délai: 24 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at movement. |
24 hours after surgery
|
|
Postoperative pain intensity at movement
Délai: 48 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at movement. |
48 hours after surgery
|
|
Postoperative pain intensity
Délai: 6 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at rest. |
6 hours after surgery
|
|
Postoperative pain intensity
Délai: 12 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at rest. |
12 hours after surgery
|
|
Postoperative pain intensity
Délai: 24 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at rest. |
24 hours after surgery
|
|
Postoperative pain intensity
Délai: 48 hours after surgery
|
Comparison of postoperative pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) at rest. |
48 hours after surgery
|
|
Postoperative opioid consumption
Délai: 48 hours after surgery
|
Comparison of cumulative opioid consumption during the postoperative period, expressed as intravenous morphine milligram equivalents (MME). |
48 hours after surgery
|
|
Time to first rescue analgesia
Délai: 48 hours after surgery
|
Comparison of the time from the end of surgery to the first administration of rescue opioid analgesia. |
48 hours after surgery
|
|
Systemic Immune-Inflammation Index (SII)
Délai: 24 hours after surgery
|
Comparison of the change in the Systemic Immune-Inflammation Index (SII) among the three study groups. |
24 hours after surgery
|
|
Systemic Immune-Inflammation Index (SII)
Délai: 12 hours after surgery
|
Comparison of the change in the Systemic Immune-Inflammation Index (SII) among the three study groups. |
12 hours after surgery
|
|
Systemic Immune-Inflammation Index (SII)
Délai: 48 hours after surgery
|
Comparison of the change in the Systemic Immune-Inflammation Index (SII) among the three study groups. |
48 hours after surgery
|
|
C-reactive protein (CRP)
Délai: 12 hours after surgery
|
Comparison of postoperative C-reactive protein (CRP) concentrations among the three study groups. |
12 hours after surgery
|
|
C-reactive protein (CRP)
Délai: 24 hours after surgery
|
Comparison of postoperative C-reactive protein (CRP) concentrations among the three study groups. |
24 hours after surgery
|
|
C-reactive protein (CRP)
Délai: 48 hours after surgery
|
Comparison of postoperative C-reactive protein (CRP) concentrations among the three study groups. |
48 hours after surgery
|
Collaborateurs et enquêteurs
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Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
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Termes liés à cette étude
Autres numéros d'identification d'étude
- 18/2026
Plan pour les données individuelles des participants (IPD)
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Description du régime IPD
De-identified individual participant data underlying the published results will be made available upon reasonable request to the corresponding author. Data will be shared after publication of the primary study results and following approval of a methodologically sound research proposal and completion of a data sharing agreement.
Délai de partage IPD
Data will be available beginning 6 months after publication of the primary results and for a period of 5 years.
Critères d'accès au partage IPD
Researchers who provide a methodologically sound proposal aimed at achieving the objectives of the approved proposal will be granted access. Requests should be directed to the corresponding author. A data access agreement will be required prior to data release.
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
- SÈVE
- ANALYTIC_CODE
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