PENG Block vs Intrathecal Morphine in Total Hip Arthroplasty

Kresimir Oremus, MD

Status and phase: Completed; Phase 4

Conditions: Postoperative Pain; Total Hip Arthroplasty

Treatments: Procedure: Sham PENG block; Drug: Intrathecal morphine; Procedure: Spinal anesthesia; Procedure: Pericapsular nerve group (PENG) block; Drug: Intrathecal placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT05308420

022021

Details and patient eligibility

About

To compare the impact of pericapsular nerve group (PENG) block to intrathecal morphine on postoperative analgesia, motor function and side effects in patients undergoing primary total hip arthroplasty under spinal anesthesia.

Full description

The study aims to confirm the non-inferiority of PENG block vs intrathecal morphine in patients undergoing total hip arthroplasty under spinal anesthesia. Non-inferiority will be assessed regarding maximum pain on a numerical rating scale at rest and during active hip flexion and regarding cumulative morphine consumption during 48 postoperative hours. Impact on quadriceps muscle motor function and side effects including pruritus, nausea and vomiting and hypotension will also be assessed.

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• adult patients with osteoarthritis of the hip scheduled for primary total hip arthroplasty under spinal anesthesia able to provide written informed consent

Exclusion criteria

• patient unwilling / unable to provide informed consent
• contraindications for any of the drugs and procedures included in the study protocol (allergies, local infection, coagulopathy)
• high risk for perioperative morbidity/mortality (ASA Physical Status Classification IV)
• preoperative use of strong opioid analgesia (due to hip pain or other acute/chronic pain condition)
• pregnancy
• substance abuse

Post Randomization Exclusion Criteria:

• change of surgical plan
• violation of study protocol

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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60 participants in 2 patient groups

PENG block

Active Comparator group

Description:

Patients scheduled for primary total hip arthroplasty after receiving spinal anesthesia will undergo pericapsular nerve group (PENG) block. Postoperative multimodal analgesia with paracetamol, etoricoxib and oxycodone

Treatment:

Procedure: Spinal anesthesia

Procedure: Pericapsular nerve group (PENG) block

Drug: Intrathecal placebo

Intrathecal morphine

Active Comparator group

Description:

Patients scheduled for primary total hip arthroplasty will receive spinal anesthesia with local anesthetic and morphine administered intrathecally. After onset of spinal anesthesia a sham PENG block will be performed. Postoperative multimodal analgesia with paracetamol, etoricoxib and oxycodone.

Treatment:

Procedure: Sham PENG block

Drug: Intrathecal morphine

Procedure: Spinal anesthesia