PENG and LFCN Block Versus FIC Block for Multimodal Analgesia After Total Hip Replacement Surgery: a Retrospective Analysis Focused on Movement (Retro-PvF)

Regional Anesthesia Clinical Trial

— Retro-PvF  

Official title:

Pericapsular Nerve Group (PENG) Block and Lateral Femoral Cutaneous Nerve (LFCN) Block Versus Fascia Iliaca (FIC) Block for Multimodal Analgesia After Total Hip Replacement Surgery: a Retrospective Analysis Focused on Movement (Retro- PvF)

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06342102
• Other study ID #: ID 4286
• Status: Not yet recruiting
• Start date: March 26, 2024
• Est. completion date: April 30, 2024

Study information

• Verified date: April 2024
• Source: Ospedale Edoardo Bassini
• Contact: Francesco Vetrone, MF
• Phone: 0039 025799
• Email: francesco.vetrone[@]asst-nordmilano.it
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Total hip arthroplasty is a major surgical procedure performed on a growing number of patients. Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and ambulation, thus expediting hospital discharge. Amongst the many peripheral nerve blocks, FIB (fascia iliaca block) has been recommended as the block of choice by many international guidelines since it offers the best pain control with a relatively low risk of motor block. PENG (pericapsular nerve group) and its association with LFCN (lateral femoral cutaneous nerve) has been proposed as an effective alternative that offers comparable, If not better, pain control with a considerably lower risk for motor block compared to FIB. Given the novelty of this block, there are few published papers on the subject, mostly case series or case reports thus justifying the need for retrospective study.

Description:

The primary outcome was the degree of residual quadriceps femoris muscle paresis assessed with the MRC (medical research council) scale at 6 hours between PENG and LCFN. The secondary outcomes were NRS (numeric rating scale) at 6,12, 24 hours, total opioid consumption expressed as milligrams of morphine equivalents (MME), time to first rescue opioid and time to first postoperative ambulation.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 80
• Est. completion date: April 30, 2024
• Est. primary completion date: March 26, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• elective total hip replacement surgery for non-traumatic hip disease,
• age over 18 years,
• complete clinical chart including type of peripheral nerve block performed,
• signed consent form for spinal anesthesia and peripheral nerve block.

Exclusion Criteria:

• preoperative opioid therapy,
• having received a peripheral nerve block other than PENG + LFCN or FICB,
• having received general anesthesia,
• incomplete chart,
• documented muscle weakness
• deviation from the established post-operative analgesia protocol.

Related Conditions & MeSH terms

• Regional Anesthesia
• Regional Anesthesia Block
• Total Hip Replacement Surgery

Intervention

Procedure:
• PENG + LFCN block
The PENG block was performed under ultrasound guidance. After skin disinfection, the needle was advanced between the psoas tendon and pubic ramus where 20 mL of 0.5% ropivacaine were injected. The LFCN block was performed following the PENG block.10 ml of 0.5% ropivacaine were injected near the nerve into the fat-filled flat tunnel (FFFT) located at the level of the superior anterior iliac spine and lateral to the sartorius muscle.
• FIC block
FICB was performed under ultrasound guidance. The needle was advanced above the fascia iliaca and 20 mL of 0.5% ropivacaine were injected

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Ospedale Edoardo Bassini

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	time to first opioid request	we studied the effect of Regional anesthesia on opioid-sparing	From date of surgery until up to 3 days after
Other	time to first postoperative ambulation	we studied the effect of Regional anesthesia on opioid-sparing	From date of surgery until up to 3 days after
Primary	Movement of the lower limb affected by surgery	The Medical Research Council (MRC) Muscle Strength Scale (ranging scale from 0 to 5 0= no visible contraction, 5=normal power) was used to assess the degree of residual quadriceps femoris muscle paresis 6 hours postoperatively.	6 hours after surgery
Secondary	pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	6 hours after surgery
Secondary	pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	12 hours after surgery
Secondary	pain control	pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"	24 hours after surgery
Secondary	Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	24 hours after surgery
Secondary	Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	6 hours after surgery
Secondary	Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses	we studied the effect of Regional anesthesia on opioid-sparing	12 hours after surgery