Background:
In recent years, regional anesthesia has become more popular because it can reduce pain and the need for strong pain medications like morphine. For hip surgery, the PENG block is already known to be effective. A newer method, called the iliopsoas plane block (IPB), is very similar and has also shown good results in hip arthroscopy. However, these two techniques have never been directly compared in patients undergoing hip replacement surgery using the posterior approach.
Goal:
This study aims to see if the IPB is just as effective as the PENG block for controlling pain and helping patients recover well after hip replacement surgery.
Method:
118 adult patients scheduled for hip replacement under spinal anesthesia will be randomly assigned to receive either: IPB: 7 ml of Ropivacaine 7.5 mg/ml PENG: 14 ml of Ropivacaine 3.75 mg/ml Both injections are given under ultrasound guidance 30 minutes before spinal anesthesia. Neither the patient, the surgeon, nor the data collector will know which technique was used.
Post-Surgery Care:
All patients will receive standard pain relief, including:
Paracetamol every 6 hours Etoricoxib once a day Morphine via a patient-controlled pump for 48 hours
Main Outcome Measured:
The primary goal is to compare pain during movement 6 hours after surgery, using a pain scale from 0 (no pain) to 10 (worst pain). The study will consider the two blocks equivalent if the difference in average pain scores is less than 1 point.
Other Outcomes:
Total morphine used in 48 hours Pain scores at rest and during movement at various time points Walking ability (2- and 6-minute walk tests, and timed-up-and-go test) Quality of recovery (using the QoR-15 questionnaire) Side effects of morphine Patient satisfaction Length of hospital stay
Safety:
Both techniques are safe and already used in clinical practice. Ultrasound guidance minimizes risks like nerve injury, bleeding, or infection.
Conclusion:
If the IPB is shown to be as effective as the PENG block, both can be considered reliable options for pain control and early recovery after hip replacement surgery.
None
None
Parallel
PENG Block
Procedure/SurgeryAlso performed under ultrasound guidance with an 80 mm B-Braun X360 needle and a 3-5 MHz curved probe. The femoral nerve, femoral artery, iliopsoas muscle, and pubic ramus are identified. The needle is inserted in-plane, and 14 ml of ropivacaine 3.75 mg/ml is injected between the psoas tendon and pubic ramus.
Iliopsoas nerve block
Procedure/SurgeryPerformed under ultrasound guidance with a curvilinear probe (5-2 MHz). The transducer is positioned transversely below the anterior superior iliac spine (ASIS), then pivoted medially. After identifying the femoral head and acetabular rim, a 22G 80 mm needle is inserted in-plane to reach the iliopsoas plane, lateral to the iliopsoas tendon. 7 ml of ropivacaine 7.5 mg/ml is then injected.
Dynamic Pain 6h postoperative
Dynamic pain score (during mobilization) at 6 hours postoperatively, measured on a 0-10 numeric rating scale (NRS). Equivalence is defined as a mean difference of less than 1 point on the NRS.
Total Morphine Consumption
Total morphine consumption at 48 hours on Patient Controlled Intravenous Analgesia device.
NRS Dynamic pain
NRS Dynamic pain score (at tight flexion) at 6 hours postoperatively, measured on a 0-10 numeric rating scale (NRS) and at 8 am, 1 pm, 6pm at postoperative day 1 and day 2. No pain: 0; Maximum pain: 10.
NRS Rest pain
NRS Rest pain score (no mobilization) at 6 hours postoperatively, measured on a 0-10 numeric rating scale (NRS) and at 8 am, 1 pm, 6pm at postoperative day 1 and day 2. No pain: 0; Maximum pain: 10.
2MWT
Distance walked in meters during 2-minute at postoperative day 1 and day 2
Click on the lead sponsor to view all of their trials.
University of Liege
Lead sponsor
Centre Hospitalier Universitaire de Liege
Collaborator
