PENG vs L-ESPB With S-ESPB for Analgesia in Total Hip Arthroplasty

Poznan University of Medical Sciences (PUMS)

Status and phase: Begins enrollment this month; Phase 4

Conditions: Hip Arthropathy; Hip Osteoarthritis; Hip Pain Chronic

Treatments: Drug: Ropivacaine 0.5% Injectable Solution; Drug: Ropivacaine 0.2% Injectable Solution

Study type: Interventional

Funder types: Other

Identifiers

NCT07180979

03/2025

Details and patient eligibility

About

The goal of this clinical trial is to evaluate whether different types of regional anesthesia can improve pain control and functional recovery after total hip arthroplasty in adult patients undergoing elective hip replacement surgery.

The main questions it aims to answer are:

Does the PENG block reduce opioid use in the first 48 hours after surgery more effectively than the combined L-ESPB + S-ESPB technique? Which method provides better pain relief, preserves muscle strength, and supports earlier mobilization? Researchers will compare the Pericapsular Nerve Group (PENG) block with the combination of Lumbar and Sacral Erector Spinae Plane Blocks (L-ESPB + S-ESPB) to see which provides better pain control, fewer side effects, and faster recovery.

Participants will:

Be randomly assigned to receive one of the two types of ultrasound-guided regional anesthesia Undergo standard hip replacement surgery under spinal anesthesia Be monitored for pain scores, opioid use, time to first walking, muscle strength, satisfaction, and side effects over the first 48 hours after surgery.

Full description

Total hip arthroplasty (THA) is associated with moderate-to-severe postoperative pain, which can impair early mobilization and functional recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) block and the erector spinae plane (ESP) block, have been introduced as motor-sparing alternatives to femoral and lumbar plexus blocks. The PENG block targets articular branches of the femoral, obturator, and accessory obturator nerves, offering effective analgesia with minimal motor blockade. Meanwhile, the lumbar ESPB (L-ESPB) and sacral ESPB (S-ESPB) may provide a broader, yet still motor-sparing, analgesic field by targeting both lumbar and sacral nerve roots involved in hip innervation.

To date, no randomized trial has compared PENG with a dual-level ESP block approach (L-ESPB + S-ESPB) in THA patients.

Enrollment: 90 estimated patients

Sex: All

Ages: 65 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥ 65 years
• ASA physical status I-III
• Elective unilateral THA via posterior or lateral approach
• Informed consent provided

Exclusion criteria

• Allergy to study drugs (ropivacaine, dexamethasone)
• Chronic opioid use (>30 MME/day)
• Coagulopathy or infection at the injection site
• BMI > 40 kg/m²
• Pre-existing motor weakness or neuropathy in the affected limb
• Cognitive impairment precluding informed consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

---

90 participants in 3 patient groups, including a placebo group

Control group

Placebo Comparator group

Description:

All participants will receive standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia according to institutional protocol.

Treatment:

Drug: Ropivacaine 0.5% Injectable Solution

PENG + LFCN

Active Comparator group

Description:

Participants in this group will receive an ultrasound-guided pericapsular nerve group (PENG) block combined with a lateral femoral cutaneous nerve (LFCN) block using local anesthetic. To preserve blinding, sham procedures will be performed at the lumbar and sacral erector spinae plane block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be administered as per institutional protocol.

Treatment:

Drug: Ropivacaine 0.2% Injectable Solution

Drug: Ropivacaine 0.2% Injectable Solution

L-ESPB + S-ESPB

Active Comparator group

Description:

Participants in this group will receive ultrasound-guided lumbar erector spinae plane block (L-ESPB) combined with sacral erector spinae plane block (S-ESPB) using local anesthetic. To preserve blinding, sham procedures will be performed at the pericapsular and lateral femoral cutaneous nerve block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be provided according to institutional protocol.

Treatment:

Drug: Ropivacaine 0.2% Injectable Solution

Drug: Ropivacaine 0.2% Injectable Solution