Comparison of Continuous Fascia Iliaca Compartment Block With Continuous PENG Block in Total Hip Replacement Cases

NCT ID: NCT06806865

Last Updated: 2025-06-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-03-15
• Study Completion Date: 2024-12-15

Brief Summary

Adequate pain management after total hip arthroplasty (THA) is crucial for early ambulation and patient satisfaction. However, due to the hip joint's innervation complexity, the optimal regional analgesia technique for THA remains controversial.

Total hip arthroplasties are critical surgeries that can take steps to improve the quality of life and functional status of patients who do not respond to conservative treatments. However, patients may present with intense pain in the immediate postoperative period, resulting in inactivity, increased risk of complications, and greater opioid consumption, resulting in adverse effects and prolonged hospital stay. The challenging management of pain is explained by the complex innervation of the hip joint, in which the articular branches of the femoral, obturator, and accessory obturator nerves are responsible for the sensory innervation of the anterior capsule.

This randomized clinical trial compares the analgesic efficacy of FICB and PENG block following THA. Our preliminary results will be postoperative pain scores. As our anesthesia clinic, we routinely perform these known methods after surgery in these cases. Traditional intravenous analgesia methods cause many undesirable side effects depending on the type of opioid used, and they are insufficient compared to regional anesthesia methods.

Detailed Description

The pericapsular nerve group (PENG) block has been reported as the first method to target the nerves that supply the hip capsule. Later, several studies said it was more effective than traditional peripheral nerve blocks at treating THA-related postoperative pain. However, a single-injection PENG block is only effective for a limited time. Little evidence supports the efficacy of continuous PENG block for postoperative pain management in THA.

Additional anesthetic techniques, such as peripheral nerve blocks, are part of the multimodal analgesic strategy and are often used to manage acute pain better. Inadequate treatment can lead to a persistent painful condition. Although numerous nerve blocks are available for this purpose, some may fail because they cover only some of the innervation of the anterior hip capsule. The trial hypothesizes that with continuous infusion of the pericapsular nerve group block (PENG block), defined in 2018, the four lateral cutaneous nerve blocks local anesthetic between the thigh-associated psoas muscle tendon plane, and the iliopubic eminence will provide adequate analgesia without causing a motor block. Compared to the infrainguinal approach, the fascia iliaca compartment block (FICB) provides better dissemination under the fascia iliaca, while the local anesthetic is administered more cranially. Desmet et al. showed that supra-inguinal FICB reduced morphine consumption and pain scores following THA. However, despite these promising results, obturator nerve block has not been clinically proven.

Total hip arthroplasties are necessary surgeries that can take steps to improve the quality of life and functional status of patients who do not respond to conservative treatments. However, patients may present with intense pain in the immediate postoperative period, resulting in inactivity, increased risk of complications, and greater opioid consumption, resulting in adverse effects and prolonged hospital stay. The challenging management of pain is explained by the complex innervation of the hip joint, in which the articular branches of the femoral, obturator, and accessory obturator nerves are responsible for the sensory innervation of the anterior capsule.

This randomized clinical trial hypothesizes that PENG block will provide better analgesia and result in fewer quadriceps muscle weakness than FICB following THA. Our preliminary results will be postoperative pain scores. Most anesthesia clinics routinely do this by diversifying these methods known after surgery. Traditional intravenous analgesia methods cause many undesirable side effects depending on the type of opioid used, and they are insufficient compared to regional anesthesia methods.

Since THA patients are generally elderly and with comorbidities, regional anesthesia techniques are safer and more effective.

This study focuses on two routine regional anesthesia techniques that can be safely applied. The trial aims to show which of these two methods is more effective.

Conditions

Postoperative Pain; Regional Anesthesia; Pain Management; Total Hip Arthroplasty

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

PENG Group (periarticular nerve group)

Continuous PENG block is the group to be applied.

Group Type: ACTIVE_COMPARATOR

Periarticular nerve group block (PENG)

Intervention Type: PROCEDURE

The pericapsular nerve group (PENG) block targets the nerves that supply the hip capsule. The continuous PENG block will be applied immediately after general anesthesia is given to the participants under ultrasound guidance. 30 ml of 0.25% bupivacaine will be used.

SIFICB Group (supra-inguinal fascia iliaca compartment block)

Continuous supra-inguinal fascia iliaca compartment block is the group to be applied.

Group Type: ACTIVE_COMPARATOR

Continuous supra-inguinal fascia iliaca compartment block (SIFICB)

Intervention Type: PROCEDURE

The supra-inguinal fascia iliaca compartment block (SIFICB) targets the femoral, lateral femoral cutaneous, and obturator nerves. Under ultrasound guidance, 30 mL of 0.25% bupivacaine is administered, followed by catheter placement for continuous infusion at 5 mL/h.

Interventions

Periarticular nerve group block (PENG)

The pericapsular nerve group (PENG) block targets the nerves that supply the hip capsule. The continuous PENG block will be applied immediately after general anesthesia is given to the participants under ultrasound guidance. 30 ml of 0.25% bupivacaine will be used.

Intervention Type: PROCEDURE

Continuous supra-inguinal fascia iliaca compartment block (SIFICB)

The supra-inguinal fascia iliaca compartment block (SIFICB) targets the femoral, lateral femoral cutaneous, and obturator nerves. Under ultrasound guidance, 30 mL of 0.25% bupivacaine is administered, followed by catheter placement for continuous infusion at 5 mL/h.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

1. Patients undergoing hip replacement for the first time

2. Patients aged 18-65 years, ASAI-II (American Society of Anesthesiology classification)

3. Patients without primary cancer and/or patients without metastatic bone fractures

4. Patients without allergy to local anaesthetics

5. Patients with an intellectual level that can use patient-controlled analgesia devices

6. Patients with a standard bleeding profile

7. Patients who gave written consent to participate in the study

Exclusion Criteria

1. patients who have had a hip replacement and/or revision

2. patients who have primary cancer and/or fractures due to bone metastasis

3. patients who have a local anaesthetic allergy and/or a history of it

4. patients who are not intellectually competent enough to use a patient-controlled anesthesia device

5. patients who have undergone reoperation due to any surgical complication (bleeding, etc.) within 24 hours after surgery

6. patients who did not give written consent to participate in the study

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Namik Kemal University

OTHER

Sponsor Role: lead

Responsible Party

Ayhan ŞAHİN

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Namık Kemal Üniversitesi

Tekirdağ, Süleymanpasa, Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

Baran O, Sahin A, Arar C. Comparative analysis of continuous pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for postoperative analgesia in total hip arthroplasty: a randomized controlled trial. J Orthop Surg Res. 2025 Aug 6;20(1):729. doi: 10.1186/s13018-025-06055-w.

Reference Type: DERIVED

PMID: 40770360 (View on PubMed)

Other Identifiers

2023.06.01.06

Identifier Type: -

Identifier Source: org_study_id