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NCT Number: NCT06342102

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

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.

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Key information

Conditions

Regional Anesthesia Block Agnosia Nervous System Diseases Neurobehavioral Manifestations Neurologic Manifestations Pathological Conditions, Signs and Symptoms Perceptual Disorders Regional Anesthesia Signs and Symptoms Total Hip Arthroplasty (THA) Total Hip Replacement Surgery

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

ASST Nord Milano - Ospedale E. Bassini

Cinisello Balsamo, Italy/Milano, 20092, Italy

About this study

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.

Who can participate

Healthy volunteers accepted: No

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

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.

Treatment and study plan

PENG + LFCN block

Procedure

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.

Other names: pericapsular nerve group block associated with lateral femoral cutaneous nerve block

FIC block

Procedure

FICB was performed under ultrasound guidance. The needle was advanced above the fascia iliaca and 20 mL of 0.5% ropivacaine were injected

Other names: fascia iliaca compartment block

Primary outcomes

  1. Movement of the lower limb affected by surgery

    Time frame: 6 hours after 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.

Secondary outcomes

  1. pain control

    Time frame: 6 hours after surgery

    pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"

  2. pain control

    Time frame: 12 hours after surgery

    pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"

  3. pain control

    Time frame: 24 hours after surgery

    pain assessment with Numeric Rating Scale (NRS): a 0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"

  4. Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses

    Time frame: 24 hours after surgery

    we studied the effect of Regional anesthesia on opioid-sparing

  5. Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses

    Time frame: 6 hours after surgery

    we studied the effect of Regional anesthesia on opioid-sparing

  6. Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid doses

    Time frame: 12 hours after surgery

    we studied the effect of Regional anesthesia on opioid-sparing

Other outcomes

  1. time to first opioid request

    Time frame: From date of surgery until up to 3 days after

    we studied the effect of Regional anesthesia on opioid-sparing

  2. time to first postoperative ambulation

    Time frame: From date of surgery until up to 3 days after

    we studied the effect of Regional anesthesia on opioid-sparing

Sponsors and collaborators

Lead sponsor

Ospedale Edoardo Bassini

Other

Registry information

Official study 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)

Acronym: Retro-PvF

Important dates

Study start
2024
Primary completion
2024
Study completion
2024
First posted
Apr 2, 2024
Registry last updated
Mar 19, 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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