PENG Block vs Suprainguinal FICB vs Lumbar ESPB for Analgesia After Hip Surgery
NCT ID: NCT07288983
Last Updated: 2025-12-17
Study Results
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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NOT_YET_RECRUITING
NA
93 participants
INTERVENTIONAL
2026-01-01
2027-01-31
Brief Summary
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The primary objective is to determine which block provides the most effective postoperative analgesia while preserving motor function and facilitating early mobilization. Secondary objectives include comparisons of opioid consumption, pain scores at rest and during movement, time to first rescue analgesia, block-related adverse events, quadriceps strength, incidence of postoperative nausea and vomiting, and early functional outcomes.
This study aims to identify the optimal motor-sparing regional anesthesia strategy for older adults undergoing hip arthroplasty.
Detailed Description
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The PENG block targets the articular branches of the femoral, obturator, and accessory obturator nerves, providing selective analgesia of the anterior hip capsule with minimal motor involvement. The suprainguinal FICB delivers a higher spread of local anesthetic over the femoral nerve, lateral femoral cutaneous nerve, and variable portions of the obturator nerve, offering broader sensory coverage but with a higher likelihood of quadriceps weakness. The lumbar ESPB is a posterior fascial plane block that may achieve indirect spread toward the lumbar plexus, potentially providing balanced anterior and posterior capsular analgesia while preserving motor function.
This randomized, double-blinded, three-arm controlled trial aims to compare the analgesic effectiveness, opioid-sparing properties, and motor-sparing characteristics of PENG, S-FICB, and L-ESPB in patients undergoing hip arthroplasty. All participants will receive standardized spinal anesthesia and multimodal postoperative analgesia. The study's primary endpoint is the time to first rescue opioid administration. Secondary outcomes include total postoperative opioid consumption, pain scores at rest and during movement, quadriceps muscle strength, block performance time, incidence of postoperative nausea and vomiting, early mobilization parameters, and block-related adverse events.
The results of this trial are expected to clarify the relative benefits and limitations of the three most commonly used motor-sparing regional anesthesia techniques for hip surgery and to guide optimal selection of blocks for enhanced recovery pathways in older adults undergoing hip arthroplasty.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
QUADRUPLE
Study Groups
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PENG block
Participants in this arm will receive a Pericapsular Nerve Group (PENG) block performed under ultrasound guidance. The block will be administered with 20 mL of 0.2% ropivacaine injected lateral to the iliopsoas tendon at the level of the anterior inferior iliac spine and iliopubic eminence. No additional peripheral nerve blocks will be performed. All participants will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Pericapsular Nerve Group (PENG) Block
The Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using a curvilinear or linear transducer. A 22-gauge echogenic needle will be advanced in-plane toward the fascial plane between the iliopsoas tendon and the pelvic brim at the level of the anterior inferior iliac spine. A total of 20 mL of 0.2% ropivacaine will be injected incrementally with repeated aspiration to avoid intravascular injection. No additional peripheral nerve blocks will be performed. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Suprainguinal FICB
Participants will receive a suprainguinal Fascia Iliaca Compartment Block (S-FICB) performed under ultrasound guidance. A total of 40 mL of 0.2% ropivacaine will be injected in the suprainguinal fascia iliaca plane to achieve spread toward the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. All participants will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Suprainguinal Fascia Iliaca Compartment Block (S-FICB)
The suprainguinal fascia iliaca compartment block will be performed under ultrasound guidance using a high-frequency linear probe placed in the sagittal oblique plane above the inguinal ligament. After identifying the fascia iliaca above the iliacus muscle, a 22-gauge echogenic needle will be advanced in-plane into the suprainguinal fascia iliaca space. A total of 30 mL of 0.2% ropivacaine will be injected to achieve cranial spread toward the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Lumbar ESPB
Participants will receive a lumbar Erector Spinae Plane Block (L-ESPB) performed under ultrasound guidance at the L4 transverse process level. A total of 20 mL of 0.2% ropivacaine will be injected deep to the erector spinae muscle and superficial to the transverse process. No sacral ESPB will be added. All participants will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Lumbar Erector Spinae Plane Block (L-ESPB)
The lumbar erector spinae plane block will be performed under ultrasound guidance at the L4 transverse process level. A curvilinear or linear ultrasound probe will be used to identify the erector spinae muscle and underlying transverse process. A 22-gauge echogenic needle will be inserted in-plane and advanced to the fascial plane deep to the erector spinae muscle and superficial to the transverse process. A total of 20 mL of 0.2% ropivacaine will be injected incrementally. No sacral ESPB will be added. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Interventions
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Pericapsular Nerve Group (PENG) Block
The Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using a curvilinear or linear transducer. A 22-gauge echogenic needle will be advanced in-plane toward the fascial plane between the iliopsoas tendon and the pelvic brim at the level of the anterior inferior iliac spine. A total of 20 mL of 0.2% ropivacaine will be injected incrementally with repeated aspiration to avoid intravascular injection. No additional peripheral nerve blocks will be performed. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Suprainguinal Fascia Iliaca Compartment Block (S-FICB)
The suprainguinal fascia iliaca compartment block will be performed under ultrasound guidance using a high-frequency linear probe placed in the sagittal oblique plane above the inguinal ligament. After identifying the fascia iliaca above the iliacus muscle, a 22-gauge echogenic needle will be advanced in-plane into the suprainguinal fascia iliaca space. A total of 30 mL of 0.2% ropivacaine will be injected to achieve cranial spread toward the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Lumbar Erector Spinae Plane Block (L-ESPB)
The lumbar erector spinae plane block will be performed under ultrasound guidance at the L4 transverse process level. A curvilinear or linear ultrasound probe will be used to identify the erector spinae muscle and underlying transverse process. A 22-gauge echogenic needle will be inserted in-plane and advanced to the fascial plane deep to the erector spinae muscle and superficial to the transverse process. A total of 20 mL of 0.2% ropivacaine will be injected incrementally. No sacral ESPB will be added. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Eligibility Criteria
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Inclusion Criteria
* Ability to provide written informed consent.
* Ability to understand and reliably use numerical pain assessment tools (NRS 0-10).
* ASA physical status II-III.
* Expected postoperative hospitalization of at least 48 hours to ensure complete data collection.
Exclusion Criteria
* Coagulopathy or therapeutic anticoagulation not meeting safety criteria for regional anesthesia.
* Local infection at the planned block site.
* Allergy, hypersensitivity, or contraindication to ropivacaine, local anesthetics, or study medications.
* Pre-existing lower-limb neurological deficits (motor or sensory) affecting outcome assessments.
* Severe spinal deformity or anatomical limitations preventing safe performance of regional blocks.
* Chronic opioid use (defined as \>30 mg oral morphine equivalents daily for more than 2 weeks).
* Severe renal failure (eGFR \<30 mL/min/1.73m²) or severe hepatic impairment.
* Uncontrolled diabetes mellitus (fasting glucose \>300 mg/dL or HbA1c \>10%).
* History of local anesthetic systemic toxicity (LAST).
* Participation in another interventional clinical trial within the past 30 days.
* Any condition deemed by investigators to interfere with protocol adherence, safety monitoring, or outcome reliability.
65 Years
100 Years
ALL
No
Sponsors
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Poznan University of Medical Sciences
OTHER
Responsible Party
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Principal Investigators
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Malgorzata Reysner, MD PhD
Role: STUDY_CHAIR
Poznań University of Medicla Sciences
Locations
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Poznan University of Medical Sciences
Poznan, , Poland
Countries
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Central Contacts
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Other Identifiers
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14/2025
Identifier Type: -
Identifier Source: org_study_id