PENG Block vs Intrathecal Morphine in Total Hip Arthroplasty

Pericapsular Nerve Group (PENG) Block vs Intrathecal Morphine for Postoperative Analgesia in Patients Undergoing Total Hip Arthroplasty: a Randomized Non-inferiority Trial

To compare the impact of pericapsular nerve group (PENG) block to intrathecal morphine on postoperative analgesia, motor function and side effects in patients undergoing primary total hip arthroplasty under spinal anesthesia.

The study aims to confirm the non-inferiority of PENG block vs intrathecal morphine in patients undergoing total hip arthroplasty under spinal anesthesia. Non-inferiority will be assessed regarding maximum pain on a numerical rating scale at rest and during active hip flexion and regarding cumulative morphine consumption during 48 postoperative hours. Impact on quadriceps muscle motor function and side effects including pruritus, nausea and vomiting and hypotension will also be assessed.

Inclusion Criteria:

• adult patients with osteoarthritis of the hip scheduled for primary total hip arthroplasty under spinal anesthesia able to provide written informed consent

Exclusion Criteria:

• patient unwilling / unable to provide informed consent
• contraindications for any of the drugs and procedures included in the study protocol (allergies, local infection, coagulopathy)
• high risk for perioperative morbidity/mortality (ASA Physical Status Classification IV)
• preoperative use of strong opioid analgesia (due to hip pain or other acute/chronic pain condition)
• pregnancy
• substance abuse

Post Randomization Exclusion Criteria:

• change of surgical plan
• violation of study protocol