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The goal of this clinical trial is to evaluate whether different types of regional anesthesia can improve pain control and functional recovery after total hip arthroplasty in adult patients undergoing elective hip replacement surgery.
The main questions it aims to answer are:
Does the PENG block reduce opioid use in the first 48 hours after surgery more effectively than the combined L-ESPB + S-ESPB technique? Which method provides better pain relief, preserves muscle strength, and supports earlier mobilization? Researchers will compare the Pericapsular Nerve Group (PENG) block with the combination of Lumbar and Sacral Erector Spinae Plane Blocks (L-ESPB + S-ESPB) to see which provides better pain control, fewer side effects, and faster recovery.
Participants will:
Be randomly assigned to receive one of the two types of ultrasound-guided regional anesthesia Undergo standard hip replacement surgery under spinal anesthesia Be monitored for pain scores, opioid use, time to first walking, muscle strength, satisfaction, and side effects over the first 48 hours after surgery.
Total hip arthroplasty (THA) is associated with moderate-to-severe postoperative pain, which can impair early mobilization and functional recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) block and the erector spinae plane (ESP) block, have been introduced as motor-sparing alternatives to femoral and lumbar plexus blocks. The PENG block targets articular branches of the femoral, obturator, and accessory obturator nerves, offering effective analgesia with minimal motor blockade. Meanwhile, the lumbar ESPB (L-ESPB) and sacral ESPB (S-ESPB) may provide a broader, yet still motor-sparing, analgesic field by targeting both lumbar and sacral nerve roots involved in hip innervation.
To date, no randomized trial has compared PENG with a dual-level ESP block approach (L-ESPB + S-ESPB) in THA patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | Placebo Comparator | All participants will receive standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia according to institutional protocol. |
|
| PENG + LFCN | Active Comparator | Participants in this group will receive an ultrasound-guided pericapsular nerve group (PENG) block combined with a lateral femoral cutaneous nerve (LFCN) block using local anesthetic. To preserve blinding, sham procedures will be performed at the lumbar and sacral erector spinae plane block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be administered as per institutional protocol. |
|
| L-ESPB + S-ESPB | Active Comparator | Participants in this group will receive ultrasound-guided lumbar erector spinae plane block (L-ESPB) combined with sacral erector spinae plane block (S-ESPB) using local anesthetic. To preserve blinding, sham procedures will be performed at the pericapsular and lateral femoral cutaneous nerve block sites (needle insertion and injection of 1-2 mL normal saline). Standard spinal anesthesia for total hip arthroplasty and multimodal postoperative analgesia will be provided according to institutional protocol. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ropivacaine 0.5% Injectable Solution | Drug | All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total opioid consumption | morphine milligram equivalents (MME) | first 48 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization | 4 hours after surgery |
| Pain scores | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Malgorzata Reysner, M.D. Ph.D. | Contact | +48 61 873 83 03 | mreysner@ump.edu.pl |
| Name | Affiliation | Role |
|---|---|---|
| Malgorzata Reysner | Poznan University of Medical Sciences | Study Chair |
| Tomasz Reysenr, M.D. | Poznan Univesity of Medical Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Poznan University of Medical Sciences | Recruiting | Poznan | 62-701 | Poland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42148589 | Derived | Reysner T, Ciftci B, Alver S, Wieczorowska-Tobis K, Reysner M. Comparison of pericapsular nerve group block combined with a lateral femoral cutaneous nerve (LFCN) block versus lumbar and sacral erector spinae plane blocks for analgesia after total hip arthroplasty: study protocol for a randomized, controlled trial with blinded outcome assessment. Pain Manag. 2026 May 18:1-8. doi: 10.1080/17581869.2026.2676100. Online ahead of print. |
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| ID | Term |
|---|---|
| D015207 | Osteoarthritis, Hip |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| D000775 | Anesthesia, Spinal |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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|
| Ropivacaine 0.2% Injectable Solution | Drug | Ultrasound-guided pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block, with sham lumbar and sacral ESPBs. PENG block: 20 mL of 0.2% ropivacaine. LFCN block: 5 mL of 0.2% ropivacaine. Sham lumbar ESPB: 1-2 mL preservative-free normal saline at lumbar ESPB site. Sham sacral ESPB: 1-2 mL preservative-free normal saline at sacral ESPB site. All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty. |
|
| Ropivacaine 0.2% Injectable Solution | Drug | Ultrasound-guided lumbar erector spinae plane block (L-ESPB) and sacral erector spinae plane block (S-ESPB), with sham PENG and LFCN blocks. Lumbar ESPB: 20 mL of 0.2% ropivacaine at L3 transverse process level. Sacral ESPB: 20 mL of 0.2% ropivacaine at sacral intermediate crest. Sham PENG block: 1-2 mL preservative-free normal saline at PENG site. Sham LFCN block: 1-2 mL preservative-free normal saline at LFCN site. All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty. |
|
| 8 hours after surgery |
| Pain scores | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization | 12 hours after surgery |
| Pain scores | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization | 24 hours after surgery |
| Pain scores | Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization | 48 hours after surgery |
| Time to ambulation | Time to ambulation is defined as the time interval (in hours) from the end of surgery (skin closure) to the patient's first successful attempt at ambulation with or without assistance, as determined by the attending physiotherapist or nursing staff. | 48 hours after surgery |
| Quadriceps muscle strength | Quadriceps muscle strength assessed using medical research council scale [range 0:5] | 4 hours after surgery |
| Quadriceps muscle strength | Quadriceps muscle strength assessed using medical research council scale [range 0:5] | 8 hours after surgery |
| Quadriceps muscle strength | Quadriceps muscle strength assessed using medical research council scale [range 0:5] | 12 hours after surgery |
| Quadriceps muscle strength | Quadriceps muscle strength assessed using medical research council scale [range 0:5] | 24 hours after surgery |
| Quadriceps muscle strength | Quadriceps muscle strength assessed using medical research council scale [range 0:5] | 48 hours after surgery |
| D012216 |
| Rheumatic Diseases |
| D000588 |
| Amines |
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |