The Ultrasound Guided Pericapsular Nerve Group and Anterior Quadratus Lumborum Blocks in Hip Replacement Surgeries

Cairo University (CU)

Status and phase: Completed; Phase 4

Conditions: Post Operative Analgesia

Treatments: Procedure: Anterior quadratus lumborum block technique (AQLB); Procedure: Pericapsular Nerve Group (PENG) block; Drug: Control Group

Study type: Interventional

Funder types: Other

Identifiers

NCT06679764

MD-16-2022

Details and patient eligibility

About

The investigators hypothesis that PENG block will produce effective opioid sparing analgesia with enhanced motor recovery more than AQLB in elderly patients undergoing total hip replacement surgeries

Full description

Aim of the work:

The aim of this study is to compare analgesic efficacy and motor recovery of the ultrasound guided anterior quadratus lumborum block and the pericapsular nerve group block

Statistical Analysis:

Data will be coded and entered using the statistical package SPSS version 22. Categorical data will be expressed frequency and proportion and will be compared by Chi2. Numerical data will be summarized using mean and standard deviation. Comparisons between groups for normally distributed data will be done using analysis of variance (ANOVA), while for non-normally distributed numeric variable will be done by Krauskal Wallis test. P value less than or equal to 0.05 will be considered statistically significant. All test will be two tailed

Enrollment: 93 patients

Sex: All

Ages: Under 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Both genders
• Type of surgery; unilateral elective total hip replacement.
• Physical status ASA I- III
• Age ≥ 65 Years.
• Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.
• Traumatic fracture hip through anterolateral approach.

Exclusion criteria

• Patient refusal.
• Patients with known sensitivity or contraindication to drugs used in the study (local anesthetics & opioids).
• History of psychological disorders and/or chronic pain.
• Pre- existing peripheral neuropathies
• Coagulopathy.
• Infection of the skin at the site of needle puncture area.
• Active cardiac condition (unstable coronary syndromes, significant arrhythmias, severe valvular disease).
• Acute respiratory disease (active chest infection, respiratory failure).
• Advanced liver disease (increased liver enzymes >3 folds) or severe kidney disease (creatinine >2).
• long operative time more than 3 hours.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

93 participants in 3 patient groups

Anterior quadratus lumborum block technique (AQLB)

Active Comparator group

Description:

AQLB performed in the lateral position. A low-frequency convex probe for the abdomen (2-5) MHz convex probe, (Siemens ACUSON X300 Ultrasound System) was placed horizontally above the iliac crest. On ultrasound, The psoas major was located on the ventral side of the transverse process, the erector spinae was located on the dorsal side of the transverse process, and the quadratus lumborum was located on the lateral side of the transverse process. A 38-mm 22-gauge regional block needle was advanced in-plane from posterior to anterior directing the needle tip in the fascial plane between the psoas major and the quadratus lumborum that was confirmed by injecting 1 ml saline and watchingt the fluil fting the muscle while not distending any of the two muscles (hydro-localization). Then 30mL of local anaesthetic (29ml of 0.25% bupivacaine + 1 ml of dexamethasone (4mgs) was injected with observation of local anaesthesia spread in the fascial plane.

Treatment:

Procedure: Anterior quadratus lumborum block technique (AQLB)

Pericapsular Nerve Group (PENG) block

Active Comparator group

Description:

With the patients in supine position, A low-frequency convex probe (2-5 MHz) in was placed in a transverse plane over the anterior inferior iliac spine and then it was rotated 45 degrees in counter-clockwise direction to be aligned with the pubic ramus. In this view, the ilio-pubic eminence, iliopsoas muscle tendon, femoral nerve and vessels was observed. With in-plane approach, a 38-mm 22-gauge (22-G, 50-mm) regional block needle inserted in-plane, from lateral to medial to place the needle tip underneath the iliopsoas tendon, exactly between the ilipsoas fascia anteriorly and the pubic ramus posteriorly. Following negative resistance and aspiration tests, correct location of the needle tip was confirmed by injecting 1 ml saline. Then, 30mL of local anaesthetic (29ml of 0.25% bupivacaine+ 1ml of dexamethasone (4mgs) was injected while observing for adequate fluid spread.

Treatment:

Procedure: Pericapsular Nerve Group (PENG) block

Control Group

Active Comparator group

Description:

Pataints received opioid analgesia with GA

Treatment:

Drug: Control Group