Comparing three motor-sparing nerve blocks for pain after hip replacement
A Randomized, Double-Blinded, Controlled Trial Comparing the Analgesic Efficacy and Motor-Sparing Properties of the Pericapsular Nerve Group (PENG) Block, Suprainguinal Fascia Iliaca Compartment Block (S-FICB), and Lumbar Erector Spinae Plane Block (L-ESPB) in Patients Undergoing Hip Arthroplasty
This trial will test whether the PENG block, suprainguinal FICB, or lumbar ESPB provides the best pain relief while preserving leg strength after hip arthroplasty in adults 65 and older.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 93 (estimated) |
| Ages | 65 Years to 100 Years |
| Sex | All |
| Sponsor | Poznan University of Medical Sciences Academic / other |
| Locations | 1 site (Poznan) |
| Trial ID | NCT07288983 on ClinicalTrials.gov |
What this trial studies
This randomized, double-blinded, three-arm controlled study enrolls adults aged 65 and older undergoing elective hip arthroplasty under spinal anesthesia and randomizes them to receive a PENG block, suprainguinal FICB, or lumbar ESPB for postoperative analgesia. Investigators will compare postoperative pain scores at rest and during movement, opioid consumption, time to first rescue analgesia, quadriceps strength, incidence of nausea and vomiting, block-related adverse events, and early mobilization. Blocks are selected for their motor-sparing potential to facilitate early mobilization, and outcome data will be collected during at least 48 hours of postoperative hospitalization. The trial aims to determine which technique best balances effective analgesia with preserved motor function to improve early functional recovery after hip surgery.
Who should consider this trial
Good fit: Ideal candidates are adults 65 years or older scheduled for elective hip arthroplasty under spinal anesthesia who can give informed consent, reliably use a numeric pain scale, meet ASA II-III criteria, and are expected to remain hospitalized for at least 48 hours.
Not a fit: Patients with coagulopathy or therapeutic anticoagulation, local infection at the block site, allergy to local anesthetics, pre-existing lower-limb neurological deficits, severe spinal deformity, chronic opioid dependence, or inability to consent or report pain are unlikely to be eligible or to receive benefit from participation.
Why it matters
Potential benefit: If successful, the trial could identify a nerve-block technique that reduces postoperative pain and opioid use while preserving quadriceps strength and enabling earlier, safer mobilization.
How similar studies have performed: Smaller randomized trials and observational studies indicate that PENG, suprainguinal FICB, and ESPB can reduce postoperative pain and opioid use, but direct head-to-head randomized comparisons of all three techniques in the same population are limited, so this comprehensive comparison is relatively novel.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * 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. * Expected postoperative hospitalization of at least 48 hours to ensure complete data collection. Exclusion Criteria: * 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. * Pre-existing lower-limb neurological deficits (motor or sensory) affecting outcome assessments. * Severe spinal deformity or anatomical limitations preventing safe performance of regional blocks. * Chronic opioid use (defined as \>30 mg oral morphine equivalents daily for more than 2 weeks). * Severe renal failure (eGFR \<30 mL/min/1.73m²) or severe hepatic impairment. * Uncontrolled diabetes mellitus (fasting glucose \>300 mg/dL or HbA1c \>10%). * History of local anesthetic systemic toxicity (LAST). * Participation in another interventional clinical trial within the past 30 days. * Any condition deemed by investigators to interfere with protocol adherence, safety monitoring, or outcome reliability.
Where this trial is running
Poznan
- Poznan University of Medical Sciences — Poznan, Poland (Recruiting)
Study contacts
- Study coordinator: Malgorzata Reysner, MD PhD
- Email: mreysner@ump.edu.pl
- Phone: +48 61 873 83 03
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.