Perioperative Analgesic Effects of PENG Versus PENG Plus LFCN Block in Hip Surgeries

Başakşehir Çam & Sakura City Hospital

Status: Active, not recruiting

Conditions: Regional Anesthesia Success; Postoperative Pain Management; Analgesia, Postoperative; HİP FRACTURE; Hip Surgery (Lateral Incision)

Treatments: Procedure: Lateral Femoral Cutaneous Nerve (LFCN) Block; Procedure: Pericapsular nerve group (PENG) block

Study type: Interventional

Funder types: Other

Identifiers

NCT07329829

BSH-ANES-MG-01

Details and patient eligibility

About

This study is designed to find the best way to control pain after hip surgery performed through a side (lateral) incision. Two different types of nerve blocks used before the operation will be compared.

In one group, patients will receive a Pericapsular Nerve Group (PENG) block, which numbs the main nerves that carry pain signals from the hip joint. In the other group, patients will receive a PENG block together with a Lateral Femoral Cutaneous Nerve (LFCN) block, which adds extra pain relief for the skin and outer part of the thigh.

A total of 72 patients between 18 and 80 years old will take part in this study. All operations will be done under spinal anesthesia. Pain levels will be measured several times during the first 24 hours after surgery using a simple 0-10 pain scale. Patients will receive pain medicine through a pump that allows them to press a button when they feel pain. The total amount of medicine used will be recorded.

The researchers will also monitor when patients first need pain medicine, when they can start walking, how satisfied they are with pain control, and if they experience side effects such as nausea or dizziness.

By comparing the two methods, the study aims to see whether adding the LFCN block to the PENG block provides better pain control, lower drug use, faster recovery, and higher patient comfort after hip surgery.

Full description

Postoperative pain following hip surgery remains a significant clinical challenge, particularly in procedures performed through a lateral incision, where both deep articular and superficial cutaneous pain components contribute to patient discomfort. Effective regional anesthesia techniques are essential to optimize postoperative analgesia, facilitate early mobilization, and reduce opioid-related adverse effects.

The Pericapsular Nerve Group (PENG) block has been introduced as a motor-sparing regional anesthesia technique targeting the articular branches of the femoral, obturator, and accessory obturator nerves, providing effective analgesia for hip joint-related pain. However, due to its limited coverage of cutaneous innervation, patients undergoing lateral incision hip surgery may continue to experience residual superficial pain.

The Lateral Femoral Cutaneous Nerve (LFCN) block selectively targets the sensory innervation of the anterolateral thigh and may complement the PENG block by addressing the cutaneous component of postoperative pain. The combined use of PENG and LFCN blocks has the potential to provide more comprehensive analgesia without compromising motor function.

This study is designed to evaluate whether the addition of an LFCN block to a standard PENG block enhances postoperative pain control and recovery outcomes in patients undergoing hip surgery via a lateral approach. By comparing these two regional anesthesia strategies, the study aims to contribute evidence-based guidance for optimizing multimodal analgesia protocols in hip surgery.

Enrollment: 72 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients aged between 18 and 80 years
• Patients scheduled for elective or trauma-related hip surgery performed through a lateral incision under spinal anesthesia
• Patients receiving a preoperative ultrasound-guided Pericapsular Nerve Group (PENG) block or a PENG block combined with a Lateral Femoral Cutaneous Nerve (LFCN) block
• American Society of Anesthesiologists (ASA) physical status I-III
• Patients with full orientation and the ability to cooperate
• Ability to understand the study procedures and provide written informed consent

Exclusion criteria

• Contraindications to regional anesthesia, including coagulopathy or local infection at the injection site
• Presence of neuropathic disorders or conditions that may affect pain perception, including chronic analgesic use
• Requirement for conversion to general anesthesia
• Postoperative admission to the intensive care unit
• Known allergy or hypersensitivity to opioids or local anesthetics
• American Society of Anesthesiologists (ASA) physical status IV-V

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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72 participants in 2 patient groups

PENG BLOCK GROUP

Experimental group

Description:

An ultrasound-guided Pericapsular Nerve Group (PENG) block will be performed preoperatively using standard local anesthetic techniques to provide postoperative analgesia in patients undergoing lateral incision hip surgery.

Treatment:

Procedure: Pericapsular nerve group (PENG) block

PENG + LFCN BLOCK GROUP

Experimental group

Description:

Patients in this group will receive a preoperative ultrasound-guided Pericapsular Nerve Group (PENG) block combined with a Lateral Femoral Cutaneous Nerve (LFCN) block for postoperative analgesia prior to lateral incision hip surgery under spinal anesthesia.

Treatment:

Procedure: Pericapsular nerve group (PENG) block

Procedure: Lateral Femoral Cutaneous Nerve (LFCN) Block