PENG Block vs. Local Anesthetic for Hip Replacement Anesthesia

Overseen By Rodrigo Araujo Monteiro da Silva, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Must not be taking: Opioids

Disqualifiers: Spinal anesthesia contraindication, Regional analgesia contraindication, Hip revision, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

140 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

Currently, the analgesic standard of care for patients undergoing total hip arthroplasty (THA) at our centre is intraoperative infiltration with a solution of local anesthetic, morphine (opioid), and ketorolac (nonsteroidal anti-inflammatory drug - NSAID). If a patient has a contraindication for the use of an opioid or NSAIDs, this infiltration is performed with a plain local anesthetic. No blocks (numbing of certain nerves to prevent pain from occurring in that area) are performed for postoperative pain in these patients. The pericapsular nerve group (PENG) block is a recently described technique with limited data in the literature that has assessed the benefits of using this nerve block for THA procedures. The purpose of this study is to investigate if the ultrasound-guided PENG block can provide non-inferior postoperative analgesia compared to local intraoperative anesthetic infiltration (ILAI) with an associated cost benefit for patients undergoing THA.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you regularly take opioids, you may not be eligible to participate.

Is the PENG Block safe for use in hip surgeries?

The PENG Block, used for pain management in hip surgeries, has been evaluated for its safety and effectiveness. Studies suggest it is generally safe, providing pain relief without affecting movement, and may reduce the need for opioids (strong painkillers) after surgery. ^{1 2 3 4 5}

How does the PENG Block treatment differ from other treatments for hip replacement anesthesia?

The PENG Block is a novel regional anesthesia technique that targets specific nerves around the hip joint to provide pain relief while preserving muscle function, unlike traditional methods that may affect motor control. ^{1 3 4 6 7}

What data supports the effectiveness of the PENG Block treatment for hip replacement anesthesia?

Research shows that the PENG Block can effectively manage pain for hip surgeries without affecting movement, making it a promising option for hip replacement anesthesia. ^{1 2 3 4 6}

Who Is on the Research Team?

Shalini Dhir, FRCPC

Principal Investigator

Western University

Are You a Good Fit for This Trial?

This trial is for adults over 18 years old who are having a total hip arthroplasty (hip replacement surgery) using a specific surgical approach. Participants must be able to give consent. It's not suitable for those with conditions that rule out the use of local anesthetics or nerve blocks.

Inclusion Criteria

I am over 18 years old.

I am having a hip replacement through a side (lateral) approach.

Ability to provide verbal/written consent to participate in this trial

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either a PENG block or a sham PENG block before spinal anesthesia, followed by intraoperative local anesthetic infiltration

1 day

1 visit (in-person)

Postoperative Monitoring

Participants are monitored for pain scores, opioid consumption, and quadriceps muscle strength at 6, 9, 12, and 24 hours following spinal anesthesia

24 hours

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Control Group
• PENG Block

Trial Overview The study compares two pain management methods in hip surgery: PENG block, which numbs certain nerves, and the standard care involving local anesthetic infiltration possibly mixed with morphine and NSAIDs. The goal is to see if PENG can match or exceed current methods in pain relief and cost-effectiveness.

How Is the Trial Designed?

Group I: PENG Block Experimental Treatment 1 Intervention

Participants will receive ultrasound-guided PENG block (PENG group) with local anesthetics (20 ml of 0.5% ropivacaine) before administration of spinal anesthesia.

Group II: Control Group Placebo Group 1 Intervention

Participants will receive a sham PENG block performed with 20ml of normal saline solution before spinal anesthesia. After, patients will receive ILAI (performed by the operating surgeon) with a plain solution of ropivacaine 0.25% 60ml.

Who Is Running the Clinical Trial?

London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

686

Recruited

427,000+

London Health Sciences Centre OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

668

Recruited

424,000+

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Lead Sponsor

Trials

678

Recruited

421,000+

Lawson Health Research Institute

Lead Sponsor

Trials

684

Recruited

432,000+

Published Research Related to This Trial

The preoperative PENG block significantly reduced both intraoperative and postoperative opioid consumption in patients undergoing hip arthroscopic surgery, indicating its efficacy in managing pain compared to systemic analgesia alone.

Patients receiving the PENG block experienced lower postoperative pain severity and fewer instances of nausea and vomiting, while also being ready for discharge sooner, suggesting a safety and comfort advantage without any reported complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. Patel, V., Patel, V., Abdallah, F., et al.[2022]

In a study of 71 patients undergoing total hip arthroplasty, the addition of a preoperative pericapsular nerve group (PENG) block significantly reduced pain scores in the recovery room compared to a placebo, indicating improved immediate postoperative analgesia.

However, this pain relief did not last beyond the recovery room, and overall postoperative pain scores, as well as other outcomes like quadriceps strength and opioid use, were similar between the PENG and placebo groups after discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Zheng, J., Pan, D., Zheng, B., et al.[2022]

The meta-analysis reviewed nine studies and found that the pericapsular nerve group (PENG) block does not significantly reduce postoperative morphine consumption or alter the timing of the first request for rescue analgesia compared to control groups.

PENG block was shown to have similar efficacy in managing pain as other nerve block methods, with no significant differences in pain scores or the incidence of postoperative nausea and vomiting, suggesting it can be a viable alternative for multimodal analgesia in hip surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. Yu, L., Shen, X., Liu, H.[2023]

In a study of 112 patients undergoing total hip arthroplasty, the addition of a pericapsular nerve group (PENG) block significantly improved the quality of recovery at 24 hours, with higher QoR-15 scores compared to those who did not receive the block.

Patients receiving the PENG block also required significantly fewer opioids postoperatively, indicating its effectiveness in reducing opioid consumption, while no complications related to the PENG block were observed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. Kukreja, P., Uppal, V., Kofskey, AM., et al.[2023]

The PENG block technique significantly reduced postoperative pain scores and opioid consumption in total hip arthroplasty (THA) patients, leading to a shorter hospital stay and improved mobility after surgery.

Patients receiving the PENG block experienced a longer duration before needing their first opioid dose, indicating effective pain management and potential for enhanced recovery pathways.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? Remily, EA., Hochstein, SR., Wilkie, WA., et al.[2022]

The PENG block technique significantly reduces opioid consumption in the first 24 hours after hip surgery compared to the fascia iliaca compartment block, indicating its efficacy in managing postoperative pain.

Despite the reduction in opioid use, there were no significant differences in pain scores or the incidence of postoperative nausea and vomiting between the two techniques, suggesting that PENG block is a safe alternative for pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis. Wang, Y., Wen, H., Wang, M., et al.[2023]

In a study involving 60 patients undergoing total hip arthroplasty, the PENG block significantly reduced postoperative pain on the first day compared to a sham block, with 47% of patients in the PENG group reporting no pain.

The PENG block preserved quadriceps muscle strength, showing no significant difference in muscle function compared to the sham group, indicating its potential for effective pain management without compromising motor function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial. Lin, DY., Brown, B., Morrison, C., et al.[2022]

Citations

1. England pubmed.ncbi.nlm.nih.gov

The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? [2022]

6. New Zealand pubmed.ncbi.nlm.nih.gov

The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis. [2023]

7. England pubmed.ncbi.nlm.nih.gov

The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial. [2022]