Comparison of the Efficacy of Pericapsular Nerve Group Block Alone Versus Pericapsular Nerve Group Block Combined With Superior Cluneal and Superior Gluteal Nerve Blocks in Patients Undergoing Hip Surgery

Ataturk University

Status: Invitation-only

Conditions: Osteonecrosis of the Femoral Head; Dysplasia of Hip Joint; Hip Osteoarthritis; Avascular Necrosis of Femur Head; Hip Surgeries

Treatments: Drug: 20 mL bupivacaine 0.25% injection; Drug: 15 ml Bupivacaine Hcl 0.25% injection

Study type: Interventional

Funder types: Other

Identifiers

NCT07255768

PENGHip

Details and patient eligibility

About

In the clinic, total hip arthroplasty is a frequently performed surgical procedure that often results in moderate to severe postoperative pain. Multimodal analgesia approaches are commonly preferred for managing this pain, and in recent years, nerve blocks targeting pelvic innervation have become increasingly prominent. Among these, the Pericapsular Nerve Group (PENG) block has gained attention for providing effective analgesia by targeting the nerves responsible for the anterior innervation of the hip capsule. However, when used alone, the PENG block may be insufficient for controlling posterior hip pain and may not provide complete analgesia.

In this context, adding blocks targeting the superior cluneal nerve and the superior gluteal nerve-both of which contribute to the sensory innervation of the posterior hip region-has been proposed to enhance the analgesic effect when combined with the PENG block. Superior cluneal and superior gluteal nerve blocks have recently been described in anatomical and clinical studies, and by affecting the structures contributing sensory input to the posterior hip capsule, they hold significant potential for improving pain management.

In this study, the investigators aimed to evaluate the contribution of superior cluneal and superior gluteal nerve blocks, when added to the PENG block, to perioperative analgesia in patients undergoing total hip arthroplasty. The investigators sought to comparatively investigate whether this combination offers superior outcomes compared with the PENG block alone. It was hypothesized that combined nerve blocks may provide similar or improved recovery scores, lower pain scores, reduced opioid consumption, and enhanced analgesic efficacy without affecting the degree of motor blockade.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Voluntary participation in the study
• Age between 18 and 80 years
• ASA physical status I, II, or III
• Male or female patients

Exclusion criteria

• Refusal to participate in the study
• Allergy to the medications to be used
• History of severe cardiac, renal, or hepatic disease
• Presence of neurological deficits or neuropathy
• History of anticoagulant use
• Previous surgery in the inguinal or suprainguinal region
• Pregnancy
• Chronic opioid use at home
• History of spinal surgery

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Application of PENG Block

Active Comparator group

Description:

Patients will be brought to the operating room one hour before surgery, and no premedication will be administered prior to their arrival. Before performing the PENG block, patients will be placed in the supine position. The ultrasound probe will be positioned in the transverse plane medial and caudal to the anterior superior iliac spine, and the anterior inferior iliac spine, iliopubic eminence, and psoas tendon will be identified. Using an in-plane technique, the needle will be advanced from lateral to medial and positioned between the psoas tendon and the periosteum. After negative aspiration, 15 mL of 0.25% bupivacaine will be administered.

Treatment:

Drug: 15 ml Bupivacaine Hcl 0.25% injection

Drug: 20 mL bupivacaine 0.25% injection

Application of PENG Block together with Superior Cluneal and Superior Gluteal Nerve Blocks

Active Comparator group

Description:

All patients will receive a PENG block, and in addition: The superior cluneal nerve block will be performed at the level of the posterior iliac crest under ultrasound guidance, along the course of the nerve, using 10 mL of 0.25% bupivacaine. The superior gluteal nerve block will be administered in the lateral decubitus position under ultrasound guidance, with 10 mL of 0.25% bupivacaine injected between the gluteal muscles along the trajectory of the nerve.

Treatment:

Drug: 20 mL bupivacaine 0.25% injection