PENG vs. QLB vs. Lumbar ESPB in Total Hip Surgery

NCT ID: NCT05600244

Last Updated: 2023-09-06

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-12-15
• Study Completion Date: 2023-10-10

Brief Summary

The aim of this study is to compare between Pericapsular Nerve Group Block, Erector Spinae Plane Block and Quadratus Lumborum Block for managing acute postoperative pain in patients undergoing total hip surgeries under spinal anesthesia.

Detailed Description

Total hip surgeries are one of the most common major orthopedic procedures to improve patient's functional status and quality of life. However, despite these advantages, the immediate postoperative period can be associated with severe pain that delays mobilization and increases hospital stay and the risk of thromboembolic events.

Various methods are used for postoperative pain management. Intravenous opioid agents are among them, but they may cause undesirable side effects, such as respiratory depression, sedation, constipation, allergic reaction, nausea, and vomiting. Thus, alternative techniques are preferred.

Conditions

Total Hip Surgery; Pericapsular Nerve; Quadratus Lumborum; ESPB

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

PENG block Technique

Patients will receive ultrasound-guided Pericapsular Nerve Group Block using 30 ml bupivacaine 0.25%.

Group Type: EXPERIMENTAL

PENG block Technique

Intervention Type: PROCEDURE

A linear probe will be used. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, 30 ml of bupivacaine 0.25% will be injected in the plane beneath the iliopsoas muscle

Lumbar ESPB Technique

Patients will receive lumbar erector spinae plane block using 30 ml bupivacaine 0.25%

Group Type: EXPERIMENTAL

Lumbar ESPB Technique

Intervention Type: PROCEDURE

Using the out-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthetic solution, 30 ml bupivacaine 0.25% will be administered leading to hydrodissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurs when administering local anesthetic . All local anesthetic will be administered to this location between the transverse process and the erector spinae muscle

Transmuscular QLB-t block Technique

Patients will receive transmuscular quadratus lumborum block using 30 ml bupivacaine 0.25%

Group Type: EXPERIMENTAL

Transmuscular QLB-t block Technique

Intervention Type: PROCEDURE

A convex transducer will be placed in the transverse plane on the flank of the patient cranial to the iliac crest. The 4th lumbar vertebral transverse process, erector spinae muscles, psoas muscle, transverse abdominis muscle, internal and externa oblique muscles, and the quadratus lumborum muscle will be identified. A 15 cm 22G insulated needle will be inserted on the posterior corner of the transducer. 30 ml bupivacaine 0.25% will be administered between the quadratus lumborum and psoas muscles into the fascial plane.

Interventions

PENG block Technique

A linear probe will be used. Puncture will be performed in a lateromedial direction until the needle tip reached the plane between the iliopsoas tendon and periosteum and between the anterior inferior iliac spine and iliopubic eminence. After a negative aspiration test, 30 ml of bupivacaine 0.25% will be injected in the plane beneath the iliopsoas muscle

Intervention Type: PROCEDURE

Lumbar ESPB Technique

Using the out-plane technique, a 22G/80-mm block needle will be advanced until it reached the transverse process. 0.5-1 ml of the prepared local anesthetic solution, 30 ml bupivacaine 0.25% will be administered leading to hydrodissection to confirm the correct location. The needle will be repositioned by pulling back a few millimeters if resistance occurs when administering local anesthetic . All local anesthetic will be administered to this location between the transverse process and the erector spinae muscle

Intervention Type: PROCEDURE

Transmuscular QLB-t block Technique

A convex transducer will be placed in the transverse plane on the flank of the patient cranial to the iliac crest. The 4th lumbar vertebral transverse process, erector spinae muscles, psoas muscle, transverse abdominis muscle, internal and externa oblique muscles, and the quadratus lumborum muscle will be identified. A 15 cm 22G insulated needle will be inserted on the posterior corner of the transducer. 30 ml bupivacaine 0.25% will be administered between the quadratus lumborum and psoas muscles into the fascial plane.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Age 18-65 years
• Both genders
• Body mass index < 40 kg/m^2
• American Society of Anesthesiologists (ASA) physical status I-III
• Posted for total hip surgeries under spinal anesthesia

Exclusion Criteria

• The presence of contraindications or allergy to local anesthetic agents
• Chronic use of opioids or corticosteroids
• Infection at the puncture site
• Coagulopathy
• Psychiatric disorders (dementia or cognitive impairment.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kafrelsheikh University

OTHER

Sponsor Role: lead

Responsible Party

Mohamed Fouad Algyar

Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Mohammad Fouad Algyar

Tanta, ElGharbiaa, Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Mohammad F. Algyar, MD

Role: CONTACT

mohammad.algaiar@med.kfs.edu.eg

111645345 ext. +20

Facility Contacts

Mohammad F Algyar, MD

Role: primary

mohammad.algaiar@med.kfs.edu.eg

00201111645345

Other Identifiers

MKSU 50-9-21

Identifier Type: -

Identifier Source: org_study_id