The Impact of Regional Motor-sparing Blocks on Early Rehabilitation Following Primary Hip or Knee Arthroplasty

Condition(s) studied

Investigational drug(s) / intervention(s)

PENG Block with Ropivacaine: A single preoperative ultrasound-guided pericapsular nerve group (PENG) block performed in patients undergoing primary unilateral total hip arthroplasty, using ropivacaine at a dose specified by the study safety protocol.

Sham PENG Block: An ultrasound-guided sham procedure performed using identical patient preparation and ultrasound visualization, without needle insertion into the target compartment or administration of study drug into the target space. Participants receive standard multimodal perioperative analgesia.

Adductor Canal Block with Ropivacaine: A single preoperative ultrasound-guided adductor canal block performed in patients undergoing primary unilateral total knee arthroplasty, using ropivacaine at a dose specified by the study safety protocol.

Sham Adductor Canal Block: An ultrasound-guided sham procedure performed using identical patient preparation and ultrasound visualization, without needle insertion into the target compartment or administration of study drug into the target space. Participants receive standard multimodal perioperative analgesia and identical intraoperative local infiltration analgesia.

Subarachnoid anesthesia: hyperbaric bupivacaine \[8-12.5 mg\] without intrathecal opioid; propofol sedation to a RASS score of 0 to -2.

Pain Reliever: Paracetamol 1 g every 6 hours (max. 4 g/day; lower dose as indicated) and celecoxib/NSAID in accordance with local practice, provided there are no contraindications.

Anti Inflammatory Drug: Intravenous dexamethasone, up to 10 mg as a single dose during surgery, provided there are no contraindications.

physical rehabilitation: The first attempt at mobilization is scheduled for 4-6 hours after the end of surgery. Antithrombotic exercises, attempts at sitting up and walking.

Study summary

The purpose of this study is to determine whether a single nerve block given before surgery can help patients regain independence and mobility more quickly after planned hip or knee replacement surgery for osteoarthritis.

Patients undergoing hip replacement will receive a PENG block, while patients undergoing knee replacement will receive an adductor canal block (ACB). Both procedures will be performed using ultrasound guidance. Some patients will receive a control procedure instead of the active nerve block. All participants will receive standard pain treatment and postoperative rehabilitation.

The main aim of the study is to compare patients' functional independence approximately 24 hours after surgery. Other outcomes will include the ability to walk independently, performance during physiotherapy, muscle strength, pain intensity, opioid use, adverse events, and readiness for hospital discharge. Participants will be followed from the preoperative visit until 90 days after surgery.

The results of this study may help determine whether these nerve blocks are a safe and effective way to support early recovery and restoration of mobility after hip or knee replacement surgery.

Eligibility

Primary outcome measure(s)

• Total mILOA/mILAS score — 6 months
  Total score on the modified mILOA/mILAS functional independence scale, ranging from 0 to 36 points, with lower scores indicating greater functional independence. The assessment will be performed by a physiotherapist blinded to treatment allocation.

Trial sites (1)

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