This randomized, double-blinded, controlled clinical trial compares three motor-sparing regional anesthesia techniques used for postoperative analgesia in patients undergoing hip arthroplasty: the Pericapsular Nerve Group (PENG) block, the suprainguinal Fascia Iliaca Compartment Block (S-FICB), and the Lumbar Erector Spinae Plane Block (L-ESPB). Although all three techniques are widely used in modern hip surgery, their relative analgesic efficacy, opioid-sparing potential, and impact on early functional recovery have not been directly compared in a single study.
The primary objective is to determine which block provides the most effective postoperative analgesia while preserving motor function and facilitating early mobilization. Secondary objectives include comparisons of opioid consumption, pain scores at rest and during movement, time to first rescue analgesia, block-related adverse events, quadriceps strength, incidence of postoperative nausea and vomiting, and early functional outcomes.
This study aims to identify the optimal motor-sparing regional anesthesia strategy for older adults undergoing hip arthroplasty.
Adults aged 65 years or older scheduled to undergo elective hip arthroplasty under spinal anesthesia.
Ability to provide written informed consent.
Ability to understand and reliably use numerical pain assessment tools (NRS 0-10).
ASA physical status II-III.
Inability to provide informed consent due to cognitive impairment, language barrier, or severe hearing/speech limitations.
Coagulopathy or therapeutic anticoagulation not meeting safety criteria for regional anesthesia.
Local infection at the planned block site.
Allergy, hypersensitivity, or contraindication to ropivacaine, local anesthetics, or study medications.
Parallel
Pericapsular Nerve Group (PENG) Block
Procedure/SurgeryThe Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using a curvilinear or linear transducer. A 22-gauge echogenic needle will be advanced in-plane toward the fascial plane between the iliopsoas tendon and the pelvic brim at the level of the anterior inferior iliac spine. A total of 20 mL of 0.2% ropivacaine will be injected incrementally with repeated aspiration to avoid intravascular injection. No additional peripheral nerve blocks will be performed. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Suprainguinal Fascia Iliaca Compartment Block (S-FICB)
Procedure/SurgeryThe suprainguinal fascia iliaca compartment block will be performed under ultrasound guidance using a high-frequency linear probe placed in the sagittal oblique plane above the inguinal ligament. After identifying the fascia iliaca above the iliacus muscle, a 22-gauge echogenic needle will be advanced in-plane into the suprainguinal fascia iliaca space. A total of 30 mL of 0.2% ropivacaine will be injected to achieve cranial spread toward the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Lumbar Erector Spinae Plane Block (L-ESPB)
Procedure/SurgeryThe lumbar erector spinae plane block will be performed under ultrasound guidance at the L4 transverse process level. A curvilinear or linear ultrasound probe will be used to identify the erector spinae muscle and underlying transverse process. A 22-gauge echogenic needle will be inserted in-plane and advanced to the fascial plane deep to the erector spinae muscle and superficial to the transverse process. A total of 20 mL of 0.2% ropivacaine will be injected incrementally. No sacral ESPB will be added. All patients will receive standardized spinal anesthesia and multimodal postoperative analgesia.
Total Opioid Consumption in the First 48 Hours After Surgery
Total cumulative opioid consumption recorded in the first 48 postoperative hours, converted to morphine milligram equivalents (MME). Includes all opioid medications administered as part of postoperative analgesia, both scheduled and rescue doses. Data will be extracted from electronic medication records and converted using standard MME conversion factors.
Time to First Rescue Opioid Administration
Time in hours from the end of surgery to the first administration of rescue opioid analgesia (5 mg intravenous oxycodone) triggered by a Numerical Rating Scale (NRS) pain score ≥ 4 or patient request.
Numerical Rating Scale (NRS) Pain Scores at Rest
Pain intensity at rest measured using the 0-10 Numerical Rating Scale (0 = no pain, 10 = worst pain). Pain will be assessed by blinded study personnel at predefined intervals.
Numerical Rating Scale (NRS) Pain Scores at Rest
Pain intensity at rest measured using the 0-10 Numerical Rating Scale (0 = no pain, 10 = worst pain). Pain will be assessed by blinded study personnel at predefined intervals.
Numerical Rating Scale (NRS) Pain Scores at Rest
Pain intensity at rest measured using the 0-10 Numerical Rating Scale (0 = no pain, 10 = worst pain). Pain will be assessed by blinded study personnel at predefined intervals.
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