QLESP Block Versus PENG+LFCN Block for Total Hip Arthroplasty

Comparison of Ultrasound-Guided QLESP Block Versus Pericapsular Nerve Group Block Combined With Lateral Femoral Cutaneous Nerve Block on Postoperative Analgesia and Functional Recovery in Total Hip Arthroplasty: A Randomized Controlled Trial

Total hip arthroplasty (THA) is a common surgery to replace damaged hip joints, but many patients experience significant pain after surgery, which can delay recovery and increase the need for strong pain medications (opioids). Nerve blocks are a technique where anesthetic medication is injected near specific nerves to reduce pain. This study compares two different ultrasound-guided nerve block techniques for pain control after THA: the QLESP block (a newer technique that targets two areas with a single injection) and the PENG block combined with the LFCN block (a currently used technique that targets nerves around the hip joint and the outer thigh). Participants in this study will be randomly assigned (like a coin flip) to receive either the QLESP block or the PENG+LFCN block after surgery. The study aims to determine which nerve block provides better pain relief and reduces the need for opioid pain medications in the first 24 hours after surgery. Pain scores, recovery of leg movement, time to first walk, length of hospital stay, and any side effects will also be compared between the two groups.

Inclusion Criteria:

• Age 18 to 70 years
• Scheduled for elective unilateral total hip arthroplasty via posterolateral approach
• American Society of Anesthesiologists (ASA) physical status I-III
• Body mass index (BMI) < 35 kg/m²
• Ability to understand pain scoring and patient-controlled analgesia (PCA) use
• Willing and able to provide written informed consent

Exclusion Criteria:

• Allergy or hypersensitivity to local anesthetics (ropivacaine)
• Long-term opioid use or chronic pain history requiring regular analgesic use
• Active malignancy or infection at the puncture site
• Severe psychiatric disorders or communication barriers
• Severe cardiopulmonary disease
• History of opioid abuse or substance dependence
• Participation in another interventional clinical trial within 3 months prior to enrollment
• Coagulation abnormalities
• Pregnancy or breastfeeding
• Any condition that, in the investigator's opinion, would compromise patient safety or data integrity