Pericapsular Nerve Group Block Versus Intrathecal Morphine for Pain After Hip Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Morpine: Preservative-free morphine hydrochloride 100 micrograms will be added to 10 mg of hyperbaric bupivacaine 0.5% and administered into the intrathecal space at the L3-L4 or L4-L5 interspace as part of spinal anesthesia.

Ultrasound-guided pericapsular nerve group block: After spinal anesthesia, an ultrasound-guided pericapsular nerve group block will be performed on the operative side. A 21 gauge, 80 to 100 mm echogenic needle will be advanced in-plane from lateral to medial into the fascial plane between the iliopubic eminence and the iliopsoas tendon, and 20 mL of bupivacaine 0.5% will be injected after negative aspiration.

Bupivacaine: Hyperbaric bupivacaine 0.5%, 10 mg, will be administered intrathecally in both groups as the spinal anesthetic. In the PENG block group, an additional 20 mL of bupivacaine 0.5% will be used for the block.

Study summary

Pain after hip replacement surgery is often severe and is commonly treated with opioids, which may cause nausea, vomiting, sedation, difficulty passing urine and slow breathing. This study will compare two ways of controlling pain in adults having hip surgery under spinal anesthesia. One group will receive morphine added to the spinal injection. The other group will receive an ultrasound-guided pericapsular nerve group (PENG) block, in which local anesthetic is injected near the nerves that carry pain signals from the hip joint. Participants will be assigned to one of the two groups by chance. Sixty-four adults aged 18 to 65 years will take part, with 32 in each group. Pain scores at rest and during movement, the total amount of morphine used through a patient-controlled pump, the time until the first request for extra pain medicine, the amount of additional paracetamol used, side effects such as nausea and vomiting, and complications related to the block will be compared between the groups during the first 48 hours after surgery.

Eligibility

Primary outcome measure(s)

• Cumulative intravenous morphine consumption at 24 hours — 0 to 24 hours after surgery
  Total amount of morphine, in milligrams, delivered by the intravenous patient-controlled analgesia device during the first 24 postoperative hours, recorded from the device log. Lower values indicate lower opioid requirement.

Trial sites (1)

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