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Functional Recovery After PENG Block Plus Periarticular Injection Versus Periarticular Injection Alone in Total Hip Arthroplasty

3 november 2026 bijgewerkt door: Poznan University of Medical Sciences

Pain after hip replacement can make it difficult for older adults to get out of bed, stand up, and walk. This study will investigate whether adding a nerve block to pain-relieving injections given during surgery helps patients regain independence sooner.

The study will include adults aged 65 years or older undergoing planned first-time hip replacement for osteoarthritis. Participants will be assigned by chance to one of two groups. Both groups will receive an injection of a local anaesthetic, ropivacaine, into tissues around the back of the hip joint during surgery. One group will also receive an ultrasound-guided pericapsular nerve group (PENG) block, which involves injecting ropivacaine near nerves that carry pain signals from the hip. Both groups will receive the same usual pain treatment and rehabilitation programme.

The main assessment will take place 24 hours after surgery. A physiotherapist who does not know the participant's treatment group will assess how much help they need to get into and out of bed, stand up, walk, and use stairs.

The study will also assess pain, use of opioid pain medicines, muscle strength, quality of recovery, and side effects. The findings will help determine whether adding a PENG block provides a meaningful benefit for recovery after hip replacement.

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

This study addresses whether the analgesic effects of adding a pericapsular nerve group (PENG) block to posterior capsular local infiltration translate into better early functional recovery after total hip arthroplasty. Reduced pain or opioid consumption alone may not reflect a patient's ability to move independently, particularly when muscle weakness, dizziness, or sedation may also limit rehabilitation.

The primary assessment will therefore focus on the assistance required to perform everyday mobility tasks at a fixed postoperative time. This approach is intended to reduce the influence of staffing schedules and differences in the timing of the first mobilization attempt. Physiotherapists will receive standardized training in administering and scoring the functional assessment. Equivalent rehabilitation opportunities will be provided to both groups, including at weekends.

For each incomplete assessment, the reason will be documented to distinguish clinical inability to perform a task from an assessment missed for organizational reasons. Walking aids, assistance provided, and factors limiting performance will also be recorded.

The trial evaluates the additional value of a standard PENG block within an otherwise standardized care pathway. As the combined strategy includes a higher total dose of ropivacaine, any observed benefit will be interpreted as an effect of the overall strategy rather than proof of an effect attributable solely to the injection location.

Functional outcomes will be interpreted alongside analgesic requirements, muscle strength, patient-reported recovery, and adverse events to assess whether the additional procedure provides a meaningful overall benefit.

Studietype

Ingrijpend

Inschrijving (Geschat)

260

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Polen
      • Poznan, Polen, 62-701
        • Poznan University of Medical Sciences
        • Contact:
    • Poznań
      • Skórzewo, Poznań, Polen, 61-701
        • Poznan University of Medical Sciences

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

65 jaar en ouder (Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Age 65 years or older.
  • Scheduled for elective primary unilateral total hip arthroplasty for osteoarthritis through a posterior surgical approach.
  • Planned spinal anaesthesia and eligibility to receive either study analgesic strategy.
  • Ability to perform basic transfers and walk independently before surgery, with a walking aid permitted.
  • Ability to understand study instructions, report pain using the Numerical Rating Scale, and complete the study questionnaires.
  • Written informed consent provided before enrollment.

Exclusion Criteria:

  • Hip arthroplasty for an acute fracture, revision arthroplasty, or planned bilateral hip arthroplasty.
  • Pre-existing requirement for physical assistance from another person during basic transfers or walking.
  • Planned postoperative restrictions that prevent weight-bearing or participation in the study's functional assessments.
  • Neurological, neuromuscular, or other musculoskeletal disease that substantially limits mobility independently of the hip condition being treated.
  • Cognitive impairment or a communication disorder that prevents informed consent or reliable completion of study assessments.
  • Known hypersensitivity to ropivacaine or another medication required for the study interventions.
  • Contraindication to spinal anaesthesia, PENG block, or posterior capsular infiltration, including local infection or a bleeding risk that cannot be managed in accordance with applicable regional anaesthesia guidelines.
  • A medical condition that makes the planned study interventions or early mobilization 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 pain or functional recovery.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Verviervoudigen

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Actieve vergelijker: Posterior Capsular Local Infiltration Analgesia Alone

Participants will receive intraoperative local infiltration of the posterior hip capsule with 20 mL of 0.2% ropivacaine (40 mg), administered by the surgeon. Participants will also receive standardized spinal anaesthesia, postoperative multimodal analgesia, rescue analgesia, and rehabilitation according to the study protocol.
Geneesmiddel: Posterior Capsular Local Infiltration Analgesia

Intraoperative infiltration of the posterior hip capsule with 20 mL of 0.2% ropivacaine (40 mg), administered by the surgeon during primary total hip arthroplasty. The infiltration technique and timing will be standardized according to the study protocol.
Experimenteel: PENG Block Plus Posterior Capsular Local Infiltration Analgesia

Participants will receive an ultrasound-guided pericapsular nerve group (PENG) block with 20 mL of 0.2% ropivacaine (40 mg), together with intraoperative local infiltration of the posterior hip capsule with 20 mL of 0.2% ropivacaine (40 mg), administered by the surgeon. The total ropivacaine dose will be 80 mg. Participants will receive the same standardized spinal anaesthesia, postoperative multimodal analgesia, rescue analgesia, and rehabilitation as the comparator group.
Geneesmiddel: Posterior Capsular Local Infiltration Analgesia

Intraoperative infiltration of the posterior hip capsule with 20 mL of 0.2% ropivacaine (40 mg), administered by the surgeon during primary total hip arthroplasty. The infiltration technique and timing will be standardized according to the study protocol.

Geneesmiddel: Ultrasound-Guided Pericapsular Nerve Group Block

Ultrasound-guided single-injection pericapsular nerve group (PENG) block using 20 mL of 0.2% ropivacaine (40 mg). The block will be performed by an anaesthesiologist using a standardized technique according to the study protocol, in addition to posterior capsular local infiltration analgesia.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Modified Iowa Level of Assistance Scale Score at 24 Hours
Tijdsspanne: 24 hours after the end of surgery

Functional recovery will be assessed using the five-item modified Iowa Level of Assistance Scale (mILAS). The scale evaluates the assistance required for supine-to-sitting transfer, sitting-to-supine transfer, sit-to-stand transfer, walking, and stair climbing. Each item is scored from 0 to 6, yielding a total score from 0 to 30. Lower scores indicate less assistance required and greater functional independence. A trained physiotherapist blinded to treatment allocation will administer the assessment according to a standardized scoring manual. The primary outcome is the total mILAS score at 24 hours after surgery.
24 hours after the end of surgery

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Modified Iowa Level of Assistance Scale Score at 48 Hours
Tijdsspanne: 48 hours after the end of surgery

Functional recovery will be assessed using the five-item modified Iowa Level of Assistance Scale (mILAS). The scale evaluates the assistance required for supine-to-sitting transfer, sitting-to-supine transfer, sit-to-stand transfer, walking, and stair climbing. Each item is scored from 0 to 6, yielding a total score from 0 to 30. Lower scores indicate less assistance required and greater functional independence. A trained physiotherapist blinded to treatment allocation will administer the assessment according to a standardized scoring manual. The primary outcome is the total mILAS score at 48 hours after surgery.
48 hours after the end of surgery
Quality of Recovery at 24 Hours
Tijdsspanne: 24 hours after the end of surgery

Patient-reported recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire. Total scores range from 0 to 150, with higher scores indicating better quality of recovery.
24 hours after the end of surgery
Quality of Recovery at 48 Hours
Tijdsspanne: 48 hours after the end of surgery

Patient-reported recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire. Total scores range from 0 to 150, with higher scores indicating better quality of recovery.
48 hours after the end of surgery
Pain Intensity at Rest
Tijdsspanne: 6 hours after the end of surgery

Pain intensity at rest assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Scores at each assessment time will be analyzed separately.
6 hours after the end of surgery
Pain Intensity at Rest
Tijdsspanne: 12 hours after the end of surgery

Pain intensity at rest assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Scores at each assessment time will be analyzed separately.
12 hours after the end of surgery
Pain Intensity at Rest
Tijdsspanne: 24 hours after the end of surgery

Pain intensity at rest assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Scores at each assessment time will be analyzed separately.
24 hours after the end of surgery
Pain Intensity at Rest
Tijdsspanne: 48 hours after the end of surgery

Pain intensity at rest assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Scores at each assessment time will be analyzed separately.
48 hours after the end of surgery
Pain Intensity During Movement
Tijdsspanne: 6 hours after the end of surgery

Pain intensity during a standardized sit-to-stand task will be assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will be asked to rate the highest pain experienced while rising from a chair. Chair height, permitted use of armrests or walking aids, and assistance provided will be standardized according to the study protocol. Inability to attempt the task and the reason will be documented rather than assigned a pain score. Scores at each assessment time will be analyzed separately.
6 hours after the end of surgery
Pain Intensity During Movement
Tijdsspanne: 12 hours after the end of surgery

Pain intensity during a standardized sit-to-stand task will be assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will be asked to rate the highest pain experienced while rising from a chair. Chair height, permitted use of armrests or walking aids, and assistance provided will be standardized according to the study protocol. Inability to attempt the task and the reason will be documented rather than assigned a pain score. Scores at each assessment time will be analyzed separately.
12 hours after the end of surgery
Pain Intensity During Movement
Tijdsspanne: 24 hours after the end of surgery

Pain intensity during a standardized sit-to-stand task will be assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will be asked to rate the highest pain experienced while rising from a chair. Chair height, permitted use of armrests or walking aids, and assistance provided will be standardized according to the study protocol. Inability to attempt the task and the reason will be documented rather than assigned a pain score. Scores at each assessment time will be analyzed separately.
24 hours after the end of surgery
Pain Intensity During Movement
Tijdsspanne: 48 hours after the end of surgery

Pain intensity during a standardized sit-to-stand task will be assessed using an 11-point Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will be asked to rate the highest pain experienced while rising from a chair. Chair height, permitted use of armrests or walking aids, and assistance provided will be standardized according to the study protocol. Inability to attempt the task and the reason will be documented rather than assigned a pain score. Scores at each assessment time will be analyzed separately.
48 hours after the end of surgery
Cumulative Opioid Consumption During the First 24 Hours
Tijdsspanne: From the end of surgery through 24 hours after surgery

Cumulative dose of all opioid analgesics administered during the first 24 postoperative hours, converted to oral morphine milligram equivalents using conversion factors prespecified in the study protocol. Participants receiving no opioids will be assigned a value of zero.
From the end of surgery through 24 hours after surgery
Cumulative Opioid Consumption During the First 48 Hours
Tijdsspanne: From the end of surgery through 48 hours after surgery.

Cumulative dose of all opioid analgesics administered during the first 48 postoperative hours, converted to oral morphine milligram equivalents using conversion factors prespecified in the study protocol. Participants receiving no opioids will be assigned a value of zero.
From the end of surgery through 48 hours after surgery.
Quadriceps Muscle Strength
Tijdsspanne: 24 hours after the end of surgery

Quadriceps muscle strength of the operated limb will be assessed using the Medical Research Council (MRC) scale, ranging from 0 (no visible or palpable muscle contraction) to 5 (normal muscle strength). A trained physiotherapist blinded to treatment allocation will assess knee extension using standardized patient positioning and testing procedures. Higher scores indicate greater muscle strength. Scores at each assessment time will be analyzed separately.
24 hours after the end of surgery
Quadriceps Muscle Strength
Tijdsspanne: 48 hours after the end of surgery

Quadriceps muscle strength of the operated limb will be assessed using the Medical Research Council (MRC) scale, ranging from 0 (no visible or palpable muscle contraction) to 5 (normal muscle strength). A trained physiotherapist blinded to treatment allocation will assess knee extension using standardized patient positioning and testing procedures. Higher scores indicate greater muscle strength. Scores at each assessment time will be analyzed separately.
48 hours after the end of surgery
Incidence of Postoperative Nausea and Vomiting
Tijdsspanne: 48 hours after surgery

Proportion of participants experiencing at least one episode of nausea or vomiting during the first 48 postoperative hours, regardless of whether antiemetic treatment is administered.
48 hours after surgery
Symptomatic Orthostatic Intolerance During Mobilization
Tijdsspanne: 48 hours after surgery.

Proportion of participants experiencing dizziness, lightheadedness, blurred vision, presyncope, or syncope during postoperative sitting, standing, or walking that requires the mobilization attempt to be interrupted or terminated.
48 hours after surgery.
Postoperative Length of Hospital Stay
Tijdsspanne: From the end of surgery to hospital discharge.

Elapsed time in hours from the end of surgery to actual hospital discharge.
From the end of surgery to hospital discharge.
Incidence of Procedure-Related Adverse Events
Tijdsspanne: From administration of the study intervention through postoperative day 30.

Proportion of participants experiencing at least one adverse event considered potentially related to the PENG block or posterior capsular infiltration, including local anaesthetic systemic toxicity, injection-site infection or hematoma, or new motor or sensory neurological deficit. Event type, onset, severity, duration, and assessed relationship to the intervention will be recorded.
From administration of the study intervention through postoperative day 30.

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Poznan University of Medical Sciences

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

1 december 2026

Primaire voltooiing (Geschat)

30 november 2027

Studie voltooiing (Geschat)

31 december 2027

Studieregistratiedata

Eerst ingediend

3 november 2026

Eerst ingediend dat voldeed aan de QC-criteria

3 november 2026

Eerst geplaatst (Werkelijk)

9 november 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

9 november 2026

Laatste update ingediend die voldeed aan QC-criteria

3 november 2026

Laatst geverifieerd

1 november 2026

Meer informatie

Termen gerelateerd aan deze studie

Andere studie-ID-nummers

  • 22/2026

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

De-identified individual participant data underlying the published study results will be available upon reasonable request. Shared data will include participant characteristics, allocated interventions, primary and secondary outcome data, and adverse events necessary to reproduce the reported analyses, together with a data dictionary. Direct identifiers will be removed, and potentially identifying variables will be modified or withheld to reduce the risk of re-identification. Data sharing will comply with participant consent, institutional requirements, and applicable data protection requirements.

IPD-tijdsbestek voor delen

Data and supporting documents will be available beginning 6 months after publication of the primary study results and will remain available for 5 years.

IPD-toegangscriteria voor delen

Researchers submitting a methodologically sound proposal may request access from the principal investigator using the contact details listed in this record. Requests must describe the research question, requested data, and planned analyses. Access will require approval by the responsible institution and, where applicable, the ethics committee, and a signed data use agreement prohibiting re-identification and unauthorized onward sharing. Approved researchers will receive the minimum dataset necessary for the agreed analyses through a secure transfer method.

IPD delen Ondersteunend informatietype

  • LEERPROTOCOOL
  • SAP
  • ANALYTIC_CODE

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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