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NCT Number: NCT07109388

Comparison of Pericapsular Nerve Group (PENG) Block With a Combined Femoral, Sciatic, Lateral Femoral Cutaneous Nerve Block for Postoperative Analgesia in Secondary Total Hip Arthroplasty; (REVPET)

The aim of this clinical trial is to compare the analgesic effect of a pericapsular nerve group (PENG) block with a combined femoral, sciatic, lateral femoral cutaneous nerve block for postoperative analgesia in patients scheduled for secondary total hip arthroplasty. The primary objective of this study is to compare postoperative pain management between the PENG block and the combined block (femoral, sciatic, lateral femoral cutaneous) by measuring postoperative morphine consumption in each of the two groups.

Participants will be randomized into two groups. Patients assigned to the PENG group will receive a PENG block with ropivacaine, followed by a sham (sciatic) block, and spinal anesthesia with isobaric bupivacaine. Patients assigned to the combined block group will receive femoral, sciatic, lateral femoral cutaneous nerve blocks with ropivacaine, followed by spinal anesthesia with isobaric bupivacaine.

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Key information

Conditions

Hip Arthroplasty Replacement Neurologic Manifestations Pain Pain, Postoperative Pathologic Processes Pathological Conditions, Signs and Symptoms Post Operative Analgesia Post Operative Pain, Acute Postoperative Complications Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

This is a single-center, prospective, superiority, randomized, double-blind, parallel-group study.

Patients will be randomized into two groups of 25 patients each, for a total enrollment plan of 50 patients. After written informed consent, patients will be allocated to one of the two groups according to a computer-generated randomization list.

The nerve blocks will be performed using ultrasound guidance.

During the surgery, 0.15 mg/kg of dexamethasone IV, 1 g paracetamol IV, 30 mg ketorolac IV, and 40 mg/kg magnesium IV will be given for postoperative analgesia.

In the PACU, pain management will be provided as needed with 2 mg of IV morphine at ten-minute intervals for pain scores >4. Once spinal motor block has resolved, the patients will be transferred to the surgical ward with a morphine patient-controlled analgesia (PCA) pump. The pump parameters will allow 2 mg boluses of morphine with a 10-minute lockout and a maximum dose of 40 mg in 4 hours.

Basal analgesia will be provided with paracetamol (1 g/6 h) and ibuprofen (400 mg/8 h). Ondansetron (4 mg IV) will be administered in case of nausea or vomiting.

A research assistant will conduct postoperative visits at 2 hours, 1 day, and 2 days postoperatively to record research data. Functional testing will be done on days 1 and 2 by physiotherapy personnel.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Male and female patients
  • ASA (American Society of Anaesthesiologists) I-III
  • 18 years of age or older
  • Patients scheduled for elective secundary hip arthroplasty
  • Able to give written conformed consent autonomously

Exclusion criteria

  • Refusal or inability to give consent
  • Allergy to any of: ropivacaine, paracetamol, ibuprofen, ketorolac, morphine, ondansetron or dexamethasone
  • Bleeding diathesis
  • Neurological deficit of the operative side
  • Existing preoperative opioid use
  • Renal insufficiency (GFR<30ml/min according to the Cockroft-Gault formula)
  • Hepatic insufficiency
  • Morbid Obésity III

Treatment and study plan

Pericapsular nerve group (PENG) block with 0.75% ropivacaine guided by ultrasound

Drug

Participants in the PENG group will first receive a sham sciatic injection; the needle will be inserted into the subcutaneous tissue and 3 ml of 0.9% NaCl will be injected. They will then receive a PENG nerve block in the supine position. A low-frequency (2-5 MHz) curvilinear ultrasound probe (BK Ultrasound) will be used to identify the anterior inferior iliac spine, the pubic eminence, and the psoas tendon with its fascial plane. A 22-gauge, 50 mm needle (SonoPlex® Pajunk) will be inserted into the fascial plane to inject 20 ml of 0.75% ropivacaine (Fresenius Kabi).

Other names: PENG block

Femoral, sciatic and lateral femoral cutaneous nerve block with 0.375% ropivacaine

Drug

Participants in the combined group will first receive a sciatic nerve block performed with the patient in a semi-prone position, the lower limb flexed at 90° (hip and knee), elevated with a cushion placed between the legs. A straight line will be drawn between the greater trochanter and the ischial tuberosity. The sciatic nerve is located approximately at the midpoint of this line. Under ultrasound guidance, the ischial tuberosity will be identified medially, the greater trochanter laterally, the gluteus maximus muscle superficially beneath the adipose tissue, and the quadratus femoris muscle in depth. A 22-gauge, 50 mm needle will then be inserted into the fascial plane to inject 20 ml of 0.375% ropivacaine. The patient is then placed supine for femoral and lateral femoral cutaneous nerve blocks. 15 ml of local anaesthetics will be injected around the femoral nerve and 5 around the lateral femoral cutaneous nerve.

Primary outcomes

  1. Cumulative postoperative morphine consumption at day 1

    Time frame: Time Frame: 24 hours postoperatively

    Description: total consumption in mg

Secondary outcomes

  1. Morphine consumption in the recovery room

    Time frame: from admission till discharge from the recovery room, up to 2 hours

    consumption in mg

  2. PCA administered morphine consumption at day 2

    Time frame: at day 2 postoperatively

    consumption in mg administered by PCA

  3. Rest and dynamic pain scores

    Time frame: At 2 hours, day 1 and day 2 postoperatively

    Visual Analogue Scale(VAS), 0-10

  4. Incidence of postoperative nausea and vomiting

    Time frame: at 2 hours, day 1 and day 2 postoperatively

    Presence of nausea or vomiting in the postoperative period

  5. Incidence of pruritus

    Time frame: at 2 hours, day 1 and day 2 postoperatively

    Presence of pruritus in the postoperative period

  6. Incidence of urinary retention requiring bladder catheterisation

    Time frame: from surgery till day 2 postoperatively

    Urinary retention requiring catheterisation

  7. Duration of analgesia

    Time frame: from the time the study procedure is performed up to 36 hours after surgery

    Time between study procedure and the first dose of iv morphine

  8. Operated limb quadriceps strength

    Time frame: At day 1 and day 2 postoperatively

    Medical Research Council Manual Muscle Testing scale, 0-5

  9. Walking test

    Time frame: At day 1 and 2 postoperatively

    Maximum distance travelled (meters)

Study contacts

Contact information is provided by the study sponsor or research team.

Eric Albrecht, Prof

CONTACT

[email protected]

+41795566341

Melissa Wüst

CONTACT

[email protected]

+41795569991

Sponsors and collaborators

Lead sponsor

Centre Hospitalier Universitaire Vaudois

Other

Registry information

Official study title

Comparison of Pericapsular Nerve Group (PENG) Block With a Combined Femoral, Sciatic, Lateral Femoral Cutaneous Nerve Block for Postoperative Analgesia in Secondary Total Hip Arthroplasty.

Acronym: REVPET

Important dates

Study start
2025
Primary completion
2027
Study completion
2027
First posted
Aug 7, 2025
Registry last updated
Sep 22, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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