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NCT Number: NCT07284615

Pericapsular Nerve Group (PENG) Block Combined With Lateral Femoral Cutaneous Nerve (LFCN) Block or Wound Infiltration for Postoperative Analgesia in Anterior Approach Total Hip Arthroplasty: A Randomized Controlled Trial

This prospective, randomized controlled trial aims to compare two multimodal regional anesthesia strategies for postoperative analgesia in elective total hip arthroplasty (THA) performed via anterior approach. Patients will be randomized to receive either a Pericapsular Nerve Group (PENG) block combined with a Lateral Femoral Cutaneous Nerve (LFCN) block, or a PENG block combined with wound infiltration (WI).

The primary outcome is postoperative pain intensity at rest, measured by Numerical Rating Scale (NRS) at 6 hours after surgery. Secondary outcomes include dynamic pain scores at 6, 24, and 48 hours, total opioid consumption, time to first rescue analgesia, quadriceps strength, hip flexion angle, length of stay, and adverse events.

All procedures are routinely used in clinical practice and carry minimal additional risk. Safety will be continuously monitored by the Principal Investigator and the study team according to an internal Safety Monitoring Plan.

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Key information

Conditions

Arthropathy of Hip Complication of Anesthesia Hip Arthropathy Hospital Stay, Length of Stay in Hospital From Time of Surgery Till Discharge Locoregional Anesthesia Opioid Consumption Regional Anesthesia Morbidity

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Ospedale Edoardo Bassini

Cinisello Balsamo, Milano, 20092, Italy

Location status: Recruiting

Location contact

Angelo Pezzi, MD

CONTACT

[email protected]

+39025799 ext. 8293

Matteo Coccolo, MD

CONTACT

[email protected]

+39025799 ext. 8271

Matteo Coccolo, MD

PRINCIPAL_INVESTIGATOR

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Age > 18 years
  • Elective total hip arthroplasty
  • Spinal (subarachnoid) anesthesia
  • Written informed consent provided by the patient or by the legal guardian, if appointed

Exclusion criteria

  • INR > 1.5
  • aPTT > 1.5
  • Platelet count < 75,000/mm³
  • Signs suggestive of infection at the puncture site
  • Absence of informed consent to the procedure
  • Documented or suspected allergy to local anesthetics

Treatment and study plan

PENG plus LFCN block

Procedure

The experimental arm will be subjected to a combination of peripheral blocks: the interfascial block of the PENG and the perinervous block of the LFCN The PENG block involves deposition of local anesthetic in the fascial plane between the psoas muscle and the superior pubic ramus. The LFCN block consists of applying local anesthetic near the nerve. The LFCN lies in the subcutaneous plane deep to the fascia lata below the anterior superior ischiatic spine.

Other names: Pericapsular nerve group block and lateral femoral cutaneous nerve block, PENG and lateral femoral cutaneous nerve block

PENG plus WI

Procedure

The control arm will receive a combination of pericapsular nerve group (PENG) block and wound infiltration (WI). The PENG block involves the deposition of local anesthetic in the fascial plane between the psoas tendon and the superior pubic ramus, under ultrasound guidance. The wound infiltration consists of the administration of local anesthetic into the subcutaneous tissue along the surgical incision

Other names: Pericapsular nerve group block and wound infiltration, PENG and WI

Primary outcomes

  1. Pain at rest control at 6h

    Time frame: six hours after performing the regional anesthesia technique

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

Secondary outcomes

  1. Pain at rest control at 24h

    Time frame: 24 hours after performing the regional anesthesia technique

    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 at rest control at 48h

    Time frame: 48 hours after performing the regional anesthesia technique

    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 on movement control at 6h

    Time frame: six hours after performing the regional anesthesia technique

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

  4. Pain on movement control at 24h

    Time frame: 24 hours after performing the regional anesthesia technique

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

  5. Pain on movement control at 48h

    Time frame: 48 hours after performing the regional anesthesia technique

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

  6. MRC at 6h

    Time frame: six hours after performing the regional anesthesia technique

    evaluation of the degree of weakness or residual paresis of the quadriceps femoris muscle on the operative side using 'the Oxford Scale' (aka Medical Research Council Manual Muscle Testing scale or MRC scale) The MRC scale is a 0-5 scale, with zero meaning "no contraction " and five meaning "Full range of motion against gravity with full resistance".

  7. MRC at 24h

    Time frame: 24 hours after performing the regional anesthesia technique

    evaluation of the degree of weakness or residual paresis of the quadriceps femoris muscle on the operative side using 'the Oxford Scale' (aka Medical Research Council Manual Muscle Testing scale or MRC scale) The MRC scale is a 0-5 scale, with zero meaning "no contraction " and five meaning "Full range of motion against gravity with full resistance".

  8. MRC at 48h

    Time frame: 48 hours after performing the regional anesthesia technique

    evaluation of the degree of weakness or residual paresis of the quadriceps femoris muscle on the operative side using 'the Oxford Scale' (aka Medical Research Council Manual Muscle Testing scale or MRC scale) The MRC scale is a 0-5 scale, with zero meaning "no contraction " and five meaning "Full range of motion against gravity with full resistance".

  9. time to first PRN opioid request

    Time frame: Time Frame: From date of surgery until up to 48 hours after

    Description: time to first PRN (pro re nata) opioid request expressed in minutes

  10. MME of PRN opioid total doses

    Time frame: From date of surgery until up to 48 hours after

    Description: Morphine Milligram Equivalents (MME) of "pro re nata" (PRN) opioid total doses we will study the effect of Regional anesthesia on opioid-sparing with the same pre-established pain relief protocol

  11. Complication

    Time frame: From date of surgery until up to 48 hours after

    any complications recorded in the first 48 hours including but not limited to: postoperative nausea and vomiting (PONV), vascular puncture, paresthesia and LA toxicity

  12. the degree of hip flexion at 6h

    Time frame: six hours after performing the regional anesthesia technique

    Hip flexion degree of the operative side is measured using Digital Angle Gauge in supine position

  13. the degree of hip flexion at 24h

    Time frame: 24 hours after performing the regional anesthesia technique

    Hip flexion degree of the operative side is measured using Digital Angle Gauge in supine position

  14. the degree of hip flexion at 48h

    Time frame: 48 hours after performing the regional anesthesia technique

    Hip flexion degree of the operative side is measured using Digital Angle Gauge in supine position

  15. Length of Hospital Stay (LOS)

    Time frame: From date of surgery until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 10 months

    Length of hospital stay will be recorded as the number of postoperative midnights spent in the Orthopedic Ward, calculated from the day of surgery (postoperative day 0) until the date of discharge or death (exitus).

Study contacts

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

Angelo Pezzi, MD

CONTACT

[email protected]

0039025799 ext. 8293

Matteo Coccolo, MD

CONTACT

[email protected]

0039025799 ext. 8271

Sponsors and collaborators

Lead sponsor

Ospedale Edoardo Bassini

Other

Registry information

Official study title

Lateral Femoral Cutaneous Nerve (LFCN) Block or Wound Infiltration (WI) Combined With Pericapsular Nerve Group (PENG) Block for Analgesia in Elective Anterior Approach Total Hip Arthroplasty: A Randomized Controlled Trial

Acronym: Peng_lfcn/WI

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Dec 16, 2025
Registry last updated
Mar 25, 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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