Comparison of PENG Associated with LFCN Block Versus FICB for Multimodal Analgesic Management in THA

NCT ID: NCT06147401

Last Updated: 2024-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

58 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-20

Study Completion Date

2024-06-01

Brief Summary

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Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and ambulation. Fascia iliaca compartment block (FIC) has been recommended since it offers the best pain control with low risk of motor block. Pericapsular nerve group block (PENG) with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FIB that offers similar pain control with a considerably lower risk of motor block. The aim of this study is to compare the afore mentioned blocks and determine which one yielded the least degree of quadriceps femoris muscle weakness and the better pain control (the lowest NRS score with least need for opioids).

Detailed Description

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This single-center, double blinded RCT investigation will be conducted at ASST Nord Milano - Bassini hospital. The study was approved by the ethics committee "Comitato Etico Territoriale Lombardia 3".

Each patient undergoing elective total hip replacement surgery with anterior approach will be subjected (unless contraindicated) to subarachnoid neuraxial anesthesia and immediately afterwards to a peripheral analgesic block: the FIC block or the association of PENG and FCLN block. The choice of block type will be randomized.

At the end of the procedure, a clinician unaware of the anesthetic technique used will assess the degree of residual motor block. Simultaneously, he will assess pain control in terms of NRS (Numerical Rating Scale) and the need for opioid use.

Conditions

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Regional Anesthesia Morbidity Arthropathy of Hip Hip Arthropathy Post Operative Pain Anesthesia Complication

Keywords

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ERAS Postoperative muscle weakness Regional Block Post Operative Analgesia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A double-blind, randomized, controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
The anesthetist in the operating room will be the only one who knows what treatment has been administered

Participant: the patient will not know the type of block he will be subjected to, because of he will already be subjected to neuraxial anesthesia.

Outcomes Assessor: a clinician external to the practice will evaluate the degree of residual paralysis after anesthesia and pain control Investigator: the statistician will not know which anesthetic technique was administered to which group

Study Groups

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PENG - LFCN Block

group in which PENG and LFCN Block was performed. After performing neuraxial anesthesia, the PENG associated with LFCN block will be performed. Under ultrasound guidance, 20ml and 5ml of Ropivacaine 0.5% will be administered respectively.

Group Type EXPERIMENTAL

PENG plus LFCN block

Intervention Type PROCEDURE

The experimental arm will be subjected to a combination of peripheral blocks: the interfascial block of the PENG and the perinervous block of the LFCN

The PENG block involves deposition of local anesthetic in the fascial plane between the psoas muscle and the superior pubic ramus.

The LFCN block consists of applying local anesthetic near the nerve. The LFCN lies in the subcutaneous plane deep to the fascia lata below the anterior superior ischiatic spine.

FIC Block

group in which FIC Block was performed After performing neuraxial anesthesia, FIC block will be performed. Under ultrasound guidance, 20 ml of Ropivacaine 0.5% will be administered.

Group Type ACTIVE_COMPARATOR

FIC Block

Intervention Type PROCEDURE

The control arm will be subjected to an interfascial block, the fascia iliaca Compartment Block.

The FICB consists in the injection of anaesthetic agents into the fascia iliaca compartment.

Interventions

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PENG plus LFCN block

The experimental arm will be subjected to a combination of peripheral blocks: the interfascial block of the PENG and the perinervous block of the LFCN

The PENG block involves deposition of local anesthetic in the fascial plane between the psoas muscle and the superior pubic ramus.

The LFCN block consists of applying local anesthetic near the nerve. The LFCN lies in the subcutaneous plane deep to the fascia lata below the anterior superior ischiatic spine.

Intervention Type PROCEDURE

FIC Block

The control arm will be subjected to an interfascial block, the fascia iliaca Compartment Block.

The FICB consists in the injection of anaesthetic agents into the fascia iliaca compartment.

Intervention Type PROCEDURE

Other Intervention Names

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Pericapsular nerve group block and lateral femoral cutaneous nerve block PENG and lateral femoral cutaneous nerve block Fascia Iliaca Compartment Block FICB

Eligibility Criteria

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Inclusion Criteria

* elective total hip replacement surgery for non-traumatic hip disease,
* THA (total hip arthroplasty) with lateral approach
* age \>18 years,
* signed consent form for spinal anesthesia and peripheral nerve block provided by the patient or legal guardian if appointed

Exclusion Criteria

* Non elective THA
* Lack of consent to the procedure
* Contraindications to performing neuraxial anesthesia (i.e. Signs suggestive of puncture site infection, INR \> 1.5, aPTT \> 1.5, PLT \< 40.000)
* Documented or suspected allergy to local anesthetics
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ospedale Edoardo Bassini

OTHER

Sponsor Role lead

Responsible Party

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Francesco Vetrone, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Ospedale Edoardo Bassini

Cinisello Balsamo, Milano, Italy

Site Status

Countries

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Italy

Other Identifiers

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3703

Identifier Type: -

Identifier Source: org_study_id