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To compare the impact of pericapsular nerve group block (PENG) versus the supra-inguinal fascia-iliaca compartment block (SFICB) in postoperative analgesia, opioid sparing and enhanced recovery after surgery of total hip arthroplasty by poster-lateral approach.
ASA physical status 1, 2 and 3 patients scheduled to undergo elective total hip arthroplasty by poster-lateral (Moore) surgical approach with spinal anesthesia.
The investigators want to confirm the non-inferiority of the SFICB compared to the PENG block on postoperative first 6 hours after surgery NRS pain score and 48 hours opioids consumption, and the difference between these in terms of early recovery and motor impact on two first day after surgery. The principal investigator perform these regional anesthesia techniques with ultrasound guided injections.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PENG block | Active Comparator | Patients scheduled for total hip arthroplasty with spinal anesthesia receive before intra-thecal injection, ultrasound-guided PENG block. Patients in PENG group receive multimodal postoperative analgesia techniques coupled with morphine PCA pump. |
|
| SFICB block | Active Comparator | Patients scheduled for total hip arthroplasty with spinal anesthesia receive before intra-thecal injection, ultrasound-guided supra-inguinal fascia iliaca compartment block. Patients in SFICB group receive multimodal postoperative analgesia techniques coupled with morphine PCA pump. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pericapsular nerves group (PENG) block | Procedure | Patients scheduled for total hip arthroplasty with spinal anesthesia receive before intra-thecal injection, ultrasound-guided PENG block with injection 20 ml of ropivacaine 0,75%, between the anterior hip articular capsule, the ilii-psoas muscle, the ileo-pubic eminence and the antero-inferior iliac spine. |
| Measure | Description | Time Frame |
|---|---|---|
| NRS 6 hours | The primary endpoint of the study will be the between-group comparisons in postoperative NRS pain scores on 0 to 10 scale. | 6 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| 6 minutes walk test | Difference in traveled distance (metres) at six minutes walking test 48 hours after surgery | 48 jours after surgery |
| Opioids secondaires side effects | Incidence of morphine related side effects in two groups |
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Inclusion Criteria:
- Adults patients scheduled to undergo elective primary total hip arthroplasty by posterior surgical approach with spinal anesthesia
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Michele Carella, MD | Contact | 003242843658 | mcarella@chuliege.be |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de Liège | Recruiting | Liège | 4000 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30063657 | Background | Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847. | |
| 30798268 | Background | Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med. 2019 Feb 22:rapm-2018-100092. doi: 10.1136/rapm-2018-100092. Online ahead of print. |
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Non-inferiority randomized controlled clinical trial
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Non-inferiority controlled RCT with two groups simple-blinded
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| Supra-inguinal fascia-iliaca compartment block | Procedure | Patients scheduled for total hip arthroplasty with spinal anesthesia receive before intra-thecal injection, ultrasound-guided supra-inguinal fascia iliaca compartment block with injection over de inguinal ligament of 40 ml of ropivacaine 0,375%, between de ilio-psoas muscle and internal oblique muscle. |
|
| Ropivacaine 0,75% in PENG block | Drug | 20 ml injection of ropivacaine 0,75% |
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| Ropivacaine 0,375% in SFICB block | Drug | 40 ml injection of ropivacaine 0,375% |
|
| 48 hours after surgery |
| QoR-15 | QoR-15 French validated questionnaire for the evaluation of recovery after surgery | 72 hours after surgery |
| 2 minutes walk test | Difference in traveled distance (metres) at two minutes walking test 24 hours after surgery | 24 hours after surgery |
| Opioid sparing | Difference in cumulated morphine consumption in first 48 hours after surgery | 48 hours after intervention |
| DN4 | Difference between the two groups in the DN4 questionnaire to assess the risk of persistent pain after surgery. | 72 hours after surgery |
| IPO | Pain management satisfaction score by revised American Pain Society Patient Outcomes Questionnaire (APS- POQ-R). | 72 hours after surgery |
| ID | Term |
|---|---|
| D003766 | Dental Occlusion |
| ID | Term |
|---|---|
| D003813 | Dentistry |
| D009063 | Dental Physiological Phenomena |
| D055688 | Digestive System and Oral Physiological Phenomena |
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