PENG Block vs. Local Anesthetic for Hip Replacement Anesthesia
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph's
Must not be taking: Opioids
Disqualifiers: Spinal anesthesia contraindication, Regional analgesia contraindication, Hip revision, others
No Placebo Group
Trial Summary
What is the purpose of this trial?Currently, the analgesic standard of care for patients undergoing total hip arthroplasty (THA) at our centre is intraoperative infiltration with a solution of local anesthetic, morphine (opioid), and ketorolac (nonsteroidal anti-inflammatory drug - NSAID). If a patient has a contraindication for the use of an opioid or NSAIDs, this infiltration is performed with a plain local anesthetic. No blocks (numbing of certain nerves to prevent pain from occurring in that area) are performed for postoperative pain in these patients. The pericapsular nerve group (PENG) block is a recently described technique with limited data in the literature that has assessed the benefits of using this nerve block for THA procedures. The purpose of this study is to investigate if the ultrasound-guided PENG block can provide non-inferior postoperative analgesia compared to local intraoperative anesthetic infiltration (ILAI) with an associated cost benefit for patients undergoing THA.
Will I have to stop taking my current medications?
The trial information does not specify if you need to stop taking your current medications. However, if you regularly take opioids, you may not be eligible to participate.
What data supports the effectiveness of the PENG Block treatment for hip replacement anesthesia?
Research shows that the PENG Block can effectively manage pain for hip surgeries without affecting movement, making it a promising option for hip replacement anesthesia.
12345Is the PENG Block safe for use in hip surgeries?
The PENG Block, used for pain management in hip surgeries, has been evaluated for its safety and effectiveness. Studies suggest it is generally safe, providing pain relief without affecting movement, and may reduce the need for opioids (strong painkillers) after surgery.
13456How does the PENG Block treatment differ from other treatments for hip replacement anesthesia?
The PENG Block is a novel regional anesthesia technique that targets specific nerves around the hip joint to provide pain relief while preserving muscle function, unlike traditional methods that may affect motor control.
12457Eligibility Criteria
This trial is for adults over 18 years old who are having a total hip arthroplasty (hip replacement surgery) using a specific surgical approach. Participants must be able to give consent. It's not suitable for those with conditions that rule out the use of local anesthetics or nerve blocks.Inclusion Criteria
I am over 18 years old.
I am having a hip replacement through a side (lateral) approach.
Ability to provide verbal/written consent to participate in this trial
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive either a PENG block or a sham PENG block before spinal anesthesia, followed by intraoperative local anesthetic infiltration
1 day
1 visit (in-person)
Postoperative Monitoring
Participants are monitored for pain scores, opioid consumption, and quadriceps muscle strength at 6, 9, 12, and 24 hours following spinal anesthesia
24 hours
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Participant Groups
The study compares two pain management methods in hip surgery: PENG block, which numbs certain nerves, and the standard care involving local anesthetic infiltration possibly mixed with morphine and NSAIDs. The goal is to see if PENG can match or exceed current methods in pain relief and cost-effectiveness.
2Treatment groups
Experimental Treatment
Placebo Group
Group I: PENG BlockExperimental Treatment1 Intervention
Participants will receive ultrasound-guided PENG block (PENG group) with local anesthetics (20 ml of 0.5% ropivacaine) before administration of spinal anesthesia.
Group II: Control GroupPlacebo Group1 Intervention
Participants will receive a sham PENG block performed with 20ml of normal saline solution before spinal anesthesia. After, patients will receive ILAI (performed by the operating surgeon) with a plain solution of ropivacaine 0.25% 60ml.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
London Health Sciences CentreLondon, Canada
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Who Is Running the Clinical Trial?
London Health Sciences Centre Research Institute and Lawson Research Institute of St. Joseph'sLead Sponsor
London Health Sciences Centre OR Lawson Research Institute of St. Joseph'sLead Sponsor
London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sLead Sponsor
Lawson Health Research InstituteLead Sponsor
References
The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. [2022]The novel pericapsular nerve group (PENG) block has recently been reported to provide effective motor-sparing local anesthetic-based analgesia to the hip joint. We aimed to evaluate the analgesic efficacy and safety of a preoperative PENG block among patients undergoing ambulatory hip arthroscopic surgery where systemic analgesia is the gold standard.
Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. [2022]We hypothesized that the addition of a preoperative pericapsular nerve group (PENG) block to intra-articular local anesthetic injection would improve analgesia after total hip arthroplasty.
The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. [2023]As an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery.
Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. [2023]The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that has been proposed as an effective motor-sparing block for total hip arthroplasty. Recent randomised studies show conflicting results regarding the analgesic efficacy of the PENG block for total hip arthroplasty.
The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? [2022]A new regional anaesthetic technique, coined the pericapsular nerve group (PENG) block, targets the anterior hip capsule by blocking the articular branches of the femoral nerve and accessory obturator nerve. In this study, we evaluated: (1) patient outcomes; (2) postoperative pain scores; and (3) postoperative opioid consumption in total hip arthroplasty (THA) patients who received a PENG block in comparison to a control group.
The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis. [2023]Patients with hip surgery often experience moderate to severe postoperative pain, and need large doses of opioids to relieve it, which is not conducive to patient rehabilitation. Pericapsular nerve group (PENG) block is a new regional block technique that is considered to reduce postoperative pain and the use of opioids. The purpose of this study was to evaluate the efficacy and safety of PENG block for postoperative analgesia after hip surgery.
The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial. [2022]The PEricapsular Nerve Group (PENG) block is a novel regional analgesia technique that provides improved analgesia in patients undergoing hip surgery while preserving motor function. In this study the PENG block was investigated for analgesia in elective total hip arthroplasty (THA).