Iliopsoas (IPB) and Pericapsular Nerve Group (PENG) Blocks Comparison on Analgesia and Recovery After Total Hip Arthroplasty

Summary

Background:

In recent years, regional anesthesia has become more popular because it can reduce pain and the need for strong pain medications like morphine. For hip surgery, the PENG block is already known to be effective. A newer method, called the iliopsoas plane block (IPB), is very similar and has also shown good results in hip arthroscopy. However, these two techniques have never been directly compared in patients undergoing hip replacement surgery using the posterior approach.

Goal:

This study aims to see if the IPB is just as effective as the PENG block for controlling pain and helping patients recover well after hip replacement surgery.

Method:

118 adult patients scheduled for hip replacement under spinal anesthesia will be randomly assigned to receive either: IPB: 7 ml of Ropivacaine 7.5 mg/ml PENG: 14 ml of Ropivacaine 3.75 mg/ml Both injections are given under ultrasound guidance 30 minutes before spinal anesthesia. Neither the patient, the surgeon, nor the data collector will know which technique was used.

Post-Surgery Care:

All patients will receive standard pain relief, including:

Paracetamol every 6 hours Etoricoxib once a day Morphine via a patient-controlled pump for 48 hours

Main Outcome Measured:

The primary goal is to compare pain during movement 6 hours after surgery, using a pain scale from 0 (no pain) to 10 (worst pain). The study will consider the two blocks equivalent if the difference in average pain scores is less than 1 point.

Other Outcomes:

Total morphine used in 48 hours Pain scores at rest and during movement at various time points Walking ability (2- and 6-minute walk tests, and timed-up-and-go test) Quality of recovery (using the QoR-15 questionnaire) Side effects of morphine Patient satisfaction Length of hospital stay

Safety:

Both techniques are safe and already used in clinical practice. Ultrasound guidance minimizes risks like nerve injury, bleeding, or infection.

Conclusion:

If the IPB is shown to be as effective as the PENG block, both can be considered reliable options for pain control and early recovery after hip replacement surgery.

Conditions

• Total Hip Arthroplasty (THA)
• Postoperative Pain Management
• Peripheral Nerve Blocks
• PENG Block
• Iliopsoas Nerve Block

Interventions

PROCEDURE

PENG Block

Also performed under ultrasound guidance with an 80 mm B-Braun X360 needle and a 3-5 MHz curved probe. The femoral nerve, femoral artery, iliopsoas muscle, and pubic ramus are identified. The needle is inserted in-plane, and 14 ml of ropivacaine 3.75 mg/ml is injected between the psoas tendon and pubic ramus.

PROCEDURE

Iliopsoas nerve block

Performed under ultrasound guidance with a curvilinear probe (5-2 MHz). The transducer is positioned transversely below the anterior superior iliac spine (ASIS), then pivoted medially. After identifying the femoral head and acetabular rim, a 22G 80 mm needle is inserted in-plane to reach the iliopsoas plane, lateral to the iliopsoas tendon. 7 ml of ropivacaine 7.5 mg/ml is then injected.

Sponsors & Collaborators

• Centre Hospitalier Universitaire de Liege

  collaborator OTHER

• University of Liege

  lead OTHER

Principal Investigators

• Michele Carella, MD, PhD, ESRA-DRA · Liège University Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-10-01

Primary Completion

2026-10-01

Completion

2026-10-10

Countries

• Belgium

Study Locations