Three versions of the PENG hip nerve block, with or without added medications, for older adults

Comparison of Standard PENG Block Versus PENG With Perineural Dexamethasone or Perineural Dexmedetomidine in Patients Aged 65 Years and Older Undergoing Hip Surgery: A Randomized Controlled Trial

This tests whether adding dexamethasone or dexmedetomidine to a PENG hip nerve block gives longer or better pain relief than the block alone for people 65 and older having hip surgery.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 120 (estimated)
• Ages: 65 Years to 100 Years
• Sex: All
• Sponsor: Poznan University of Medical Sciences (other)
• Locations: 1 site (Poznan)
• Trial ID: NCT07330999 on ClinicalTrials.gov

What this trial studies

This randomized trial compares three PENG (Pericapsular Nerve Group) block approaches in adults aged 65 and older undergoing hip surgery. All participants receive a PENG block with 20 mL of 0.2% ropivacaine and are randomized to receive either ropivacaine alone, ropivacaine plus 4 mg perineural dexamethasone, or ropivacaine plus 25 µg perineural dexmedetomidine. The study will measure postoperative pain control, duration of analgesia, and early recovery outcomes such as opioid consumption and time to mobilization. The PENG block is intended to target hip joint sensory nerves while preserving motor function, and the trial tests whether small perineural adjuvants extend or improve analgesia in older patients.

Who should consider this trial

Good fit: Ideal candidates are people aged 65 or older scheduled for elective or emergency hip surgery who are planned to receive a PENG block, are ASA I–III, and can give informed consent.

Not a fit: Patients with contraindications to regional anesthesia or the study drugs (for example allergy, coagulopathy, local infection), pre-existing neuropathy of the affected limb, chronic daily opioid use, severe hepatic or renal impairment, or inability to consent may not receive benefit from participation.

Why it matters

Potential benefit: If successful, adding an adjuvant could provide longer-lasting hip pain relief after surgery, reduce opioid needs, and promote earlier mobilization in older adults.

How similar studies have performed: Perineural dexamethasone and dexmedetomidine have prolonged analgesia in other peripheral nerve blocks, but direct comparative evidence for these adjuvants with the PENG block in older adults is limited.

Eligibility criteria

Inclusion Criteria:

* Age 65 years or older
* Scheduled for elective or emergency hip surgery (e.g., hip fracture fixation or hip arthroplasty)
* ASA physical status I-III
* Planned use of a PENG block as part of perioperative analgesia
* Ability to communicate pain intensity using the NRS scale
* Written informed consent obtained from the patient or legal representative

Exclusion Criteria:

* Refusal or inability to provide informed consent
* Known allergy, intolerance, or contraindication to any of the study medications: ropivacaine, dexamethasone, dexmedetomidine
* Pre-existing neurological deficit or neuropathy in the affected limb
* Coagulopathy or laboratory abnormality that contraindicates regional anesthesia: INR \>1.5, or platelet count \<100,000/µL, or therapeutic anticoagulation that cannot be safely paused
* Infection at or near the needle insertion site
* Severe hepatic or renal impairment
* Chronic opioid therapy (\>30 days of daily opioids before surgery)
* Cognitive impairment or delirium that prevents reliable pain assessment
* BMI \>40 kg/m² (due to potential technical difficulty and reduced accuracy of ultrasound guidance)
* Previous regional block affecting the target area for the current surgery
* Pregnancy or breastfeeding
* Participation in another interventional clinical trial within 30 days

Where this trial is running

Poznan

• Poznan University of Medical Sciences — Poznan, Poland (RECRUITING)

Study contacts

• Study coordinator: Malgorzata Reysner, MD PhD

Conditions: Hip Osteoarthritis