Pericapsular Nerve Group Block for Total Hip Arthroplasty

University Tunis El Manar

Status: Completed

Conditions: Postoperative Pain; Hip Arthropathy

Treatments: Procedure: Pericapsular nerve group block with saline solution; Procedure: Pericapsular nerve group block with ropivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT04295408

CE-IMKO 103/2019

Details and patient eligibility

About

Controlling pain after hip replacement surgery improves comfort and partient satisfaction. Pain after hip replacement has traditionally been managed using systemic pain medications including acetaminophen and non-steroidal anti-inflammatory drugs. A recent Cochrane review demonstrated that compared to systemic analgesia alone, peripheral nerve blocks reduce postoperative pain with moderate-quality evidence. Pericapsular Nerve Group block is a new technique allowing local anesthetic diffusion to femoral, obturator and accessory obturator nerves and providing a good analgesic effect for hip fracture surgery. Investigators hypothesized that the PENG block could be an interesting alternative to systemic analgesiscs for pain control after total hip replacement.

Full description

The aim of the study was to evaluate the efficacy of the PENG block for intra and postoperative pain control in total hip arthroplasty.

it was a monocentric, randomized, controlled and double blind study. Patients scheduled for primary THA with lateral approach under general anesthesia.

Premedication with IV midazolam 1 to 2 mg on arrival to operating theatre. general anesthesia was conducted using fentanyl, propofol and cisatracurium for induction and isoflurane for maintanance patients were randomized using a random table in two groups:

• PENG Block group (PG) who received 2 mg.kg-1Ropivacaine in 40 ml of saline.
• Placebo group (SG) who received 40 ml of saline.

Postoperative analgesia started before extubation of the patient, with:

• IV paracetamol 1g/6h in Day1 and oral paracetamol 1g/8h for 6 days.
• non steroidal anti inflammatory drugs with IM piroxicam 20 mg on day one (at the end of surgery) and oral diclofenac 50 mg/12h for 3 days.
• Morphine PCA for day 1 (24 H) and oral tramadol 50 mg/12h from day 2 to day 6.

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• primary THA with lateral approach under general anesthesia.

Exclusion criteria

• Hip fracture,
• allergy to local anesthetics,
• peripheral neuropathy,
• creatinin clearance inferior to 30ml/min,
• weight inferior to 50 Kg or superior to 100 Kg,
• neurological disorder affecting the lower extremity, significant psychiatric conditions,
• patients receiving corticosteroid therapy,
• chronic consumption of opioids (>2 months).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups, including a placebo group

PLACEBO

Placebo Comparator group

Description:

Pericapsular Nerve Group block with 40 ml saline

Treatment:

Procedure: Pericapsular nerve group block with saline solution

Pericapsular nerve group block

Experimental group

Description:

Pericapsular Nerve Group block with 2 mg.kg-1Ropivacaine in 40 ml of saline

Treatment:

Procedure: Pericapsular nerve group block with ropivacaine