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NCT Number: NCT07180979

PENG vs L-ESPB With S-ESPB for Analgesia in Total Hip Arthroplasty

The goal of this clinical trial is to evaluate whether different types of regional anesthesia can improve pain control and functional recovery after total hip arthroplasty in adult patients undergoing elective hip replacement surgery.

The main questions it aims to answer are:

Does the PENG block reduce opioid use in the first 48 hours after surgery more effectively than the combined L-ESPB + S-ESPB technique? Which method provides better pain relief, preserves muscle strength, and supports earlier mobilization? Researchers will compare the Pericapsular Nerve Group (PENG) block with the combination of Lumbar and Sacral Erector Spinae Plane Blocks (L-ESPB + S-ESPB) to see which provides better pain control, fewer side effects, and faster recovery.

Participants will:

Be randomly assigned to receive one of the two types of ultrasound-guided regional anesthesia Undergo standard hip replacement surgery under spinal anesthesia Be monitored for pain scores, opioid use, time to first walking, muscle strength, satisfaction, and side effects over the first 48 hours after surgery.

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Key information

Conditions

Hip Osteoarthritis Arthritis Hip Arthropathy Hip Pain Chronic Joint Diseases Musculoskeletal Diseases Osteoarthritis Osteoarthritis, Hip Rheumatic Diseases

Age range

65 year–100 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Poznan University of Medical Sciences

Poznan, 62-701, Poland

Location status: Recruiting

Location contact

Malgorzata Reysner, M.D. Ph.D.

CONTACT

[email protected]

+48 61 873 83 03

About this study

Total hip arthroplasty (THA) is associated with moderate-to-severe postoperative pain, which can impair early mobilization and functional recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) block and the erector spinae plane (ESP) block, have been introduced as motor-sparing alternatives to femoral and lumbar plexus blocks. The PENG block targets articular branches of the femoral, obturator, and accessory obturator nerves, offering effective analgesia with minimal motor blockade. Meanwhile, the lumbar ESPB (L-ESPB) and sacral ESPB (S-ESPB) may provide a broader, yet still motor-sparing, analgesic field by targeting both lumbar and sacral nerve roots involved in hip innervation.

To date, no randomized trial has compared PENG with a dual-level ESP block approach (L-ESPB + S-ESPB) in THA patients.

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Age ≥ 65 years
  • ASA physical status I-III
  • Elective unilateral THA via posterior or lateral approach
  • Informed consent provided

Exclusion criteria

  • Allergy to study drugs (ropivacaine, dexamethasone)
  • Chronic opioid use (>30 MME/day)
  • Coagulopathy or infection at the injection site
  • BMI > 40 kg/m²
  • Pre-existing motor weakness or neuropathy in the affected limb
  • Cognitive impairment precluding informed consent

Treatment and study plan

Ropivacaine 0.5% Injectable Solution

Drug

All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.

Other names: Spinal Anesthesia

Ropivacaine 0.2% Injectable Solution

Drug

Ultrasound-guided pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block, with sham lumbar and sacral ESPBs.

PENG block: 20 mL of 0.2% ropivacaine. LFCN block: 5 mL of 0.2% ropivacaine. Sham lumbar ESPB: 1-2 mL preservative-free normal saline at lumbar ESPB site. Sham sacral ESPB: 1-2 mL preservative-free normal saline at sacral ESPB site. All patients will receive standard spinal anesthesia with 0.5% ropivacaine, 10-15 mg intrathecally for total hip arthroplasty.

Primary outcomes

  1. Total opioid consumption

    Time frame: first 48 hours postoperatively

    morphine milligram equivalents (MME)

Secondary outcomes

  1. Pain scores

    Time frame: 4 hours after surgery

    Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization

  2. Pain scores

    Time frame: 8 hours after surgery

    Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization

  3. Pain scores

    Time frame: 12 hours after surgery

    Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization

  4. Pain scores

    Time frame: 24 hours after surgery

    Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization

  5. Pain scores

    Time frame: 48 hours after surgery

    Numeric Rating Scale (NRS), ranging from 0 ("no pain") to 10 ("the worst pain imaginable")- at rest and during mobilization

  6. Time to ambulation

    Time frame: 48 hours after surgery

    Time to ambulation is defined as the time interval (in hours) from the end of surgery (skin closure) to the patient's first successful attempt at ambulation with or without assistance, as determined by the attending physiotherapist or nursing staff.

  7. Quadriceps muscle strength

    Time frame: 4 hours after surgery

    Quadriceps muscle strength assessed using medical research council scale [range 0:5]

  8. Quadriceps muscle strength

    Time frame: 8 hours after surgery

    Quadriceps muscle strength assessed using medical research council scale [range 0:5]

  9. Quadriceps muscle strength

    Time frame: 12 hours after surgery

    Quadriceps muscle strength assessed using medical research council scale [range 0:5]

  10. Quadriceps muscle strength

    Time frame: 24 hours after surgery

    Quadriceps muscle strength assessed using medical research council scale [range 0:5]

  11. Quadriceps muscle strength

    Time frame: 48 hours after surgery

    Quadriceps muscle strength assessed using medical research council scale [range 0:5]

Study contacts

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

Malgorzata Reysner, M.D. Ph.D.

CONTACT

[email protected]

+48 61 873 83 03

Sponsors and collaborators

Lead sponsor

Poznan University of Medical Sciences

Other

Registry information

Official study title

Comparison of Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block (L-ESPB) Combined With Sacral ESPB (S-ESPB) for Analgesia in Total Hip Arthroplasty (THA): A Randomized Clinical Trial

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Sep 18, 2025
Registry last updated
May 7, 2026

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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