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Anesthesia, ConductionNCT05749367

Lateral Cutaneous Nerve and PENG Blocks Versus Suprainguinal Fascia Iliaca Block in Post-op Analgesia of Hip Fractures

A study testing Ropivacaine + saline solution and Saline solution + Ropivacaine in people with Anesthesia, Conduction, run by Federal University of Minas Gerais at 1 site in Brazil.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Postoperative pain in hip fractures is challenging and requires adequate management. Peripheral nerve blocks are already known as superior than systemic analgesia in this scenario, but the best analgesic regional technique is still unknown. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Anesthesia, Conduction
What is being tested?
Ropivacaine + saline solution and Saline solution + Ropivacaine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
66 participants
Where
1 siteBrazil
Study dates
6 Mar 2023to 10 Oct 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with hip fractures who will undergo surgical treatment.
  • Adults over 18 years.
  • American Society of Anesthesiology physical status 1 to 3.
  • Body mass index (BMI) < 35 Kg/m2.

Who cannot join

  • Local anesthetic allergy
  • Coagulopathy
  • American Society of Anesthesiology physical status ≥ 4,
  • Dementia
  • Peripheral polyneuropathy
  • Pregnancy
Show all 11Show fewer
  • Chronic opioid use (> 3 months)
  • BMI >35 Kg/m2
  • Stroke with lower limb motor sequelae
  • Patient refusal/withdrawal
  • Those whose spinal anesthesia has been changed to general anesthesia.

Trial locations and contacts

1 site in 1 country.

Leonardo SG Oliveira, MD contact

55 31988870672

saraivaleo@gmail.com

Renato S Gomez, Ph.D contact

55 31988619475

renatogomez2000@yahoo.com.br

Brazil1 site
  • Hospital Odilon Behrens

    Belo Horizonte, Minas Gerais, 31.110-430

    Leonardo SG Oliveira, MD, 55 31988870672, saraivaleo@gmail.com

    Renata A Chaves, MD, 55 31992772423, re_chaves@hotmail.com

Other trials in Brazil

About this study

Official title: Lateral Femoral Cutaneous Nerve and Pericapsular Nerve Group (PENG) Blocks Versus Suprainguinal Fascia Iliaca Block in Postoperative Analgesia of Hip Fractures: a Prospective, Controlled, Randomized and Double Blind Study

Postoperative pain in hip fractures is challenging and requires adequate management. Peripheral nerve blocks are already known as superior than systemic analgesia in this scenario, but the best analgesic regional technique is still unknown. The investigators propose a study to compare the postoperative analgesia of hip fractures between pericapsular nerve group block plus lateral femoral cutaneous nerve block and suprainguinal fascia iliaca block

Read the detailed description

Postoperative pain in hip fractures is challenging and requires adequate management. In this scenario, peripheral nerve blocks present superior results to systemic analgesia, minimizing the use of opioids and their adverse effects. The lumbar plexus is responsible for the nociception of the hip joint through the femoral, obturator, and accessory obturator nerves, besides being responsible for the sensory innervation of the lateral aspect of the thigh through the lateral femoral cutaneous nerve. Due to this intricate network, several regional techniques have already been proposed. However, the best analgesic approach is still unknown. Ultrasound-guided suprainguinal fascia iliaca block (SIFIB), which addresses the femoral and lateral femoral cutaneous nerves, and ultrasound-guided pericapsular nerve group block (PENG), which addresses terminal branches of the femoral and accessory obturator nerves, are techniques currently used successfully in the context of analgesia for hip surgery. PENG block generates less motor impairment of the quadriceps, which can be significant in terms of mobility and rehabilitation. Both techniques show similar analgesic results in the still scarce literature, but SIFIB has shown slight advantage in some scenarios. However, the PENG block does not reach the lateral cutaneous nerve, which may lead to greater postoperative pain perception. In an attempt to fill this knowledge gap, the investigators propose a study to analyze whether the association between PENG block and lateral femoral cutaneous nerve block (LFCNB) promotes postoperative analgesia equal to SIFIB in a population of adults with hip fractures. This will be a prospective, controlled, randomized, double blind study. Patients with hip fractures (femoral neck, transtrochanteric and subtrochanteric) who will undergo surgical treatment (hip arthroplasty and osteosynthesis with intramedullary nails or screws) will be recruited and randomly allocated into two groups: control (C) and experimental (E). In group C, patients will undergo SIFIB with 30 ml of 0.5% ropivacaine, and to maintain blinding they will also undergo PENG and LFCNB with 20 ml and 10 ml of saline, respectively. In group E, patients will receive the PENG block associated with LFCNB, with 20ml + 10ml of 0.5% ropivacaine, respectively, and 30 ml of saline solution in the SIFIB. After performing the blocks, all patients will undergo spinal anesthesia, with intrathecal injection of 10mg of 0.5% isobaric bupivacaine. As a primary objective, the investigators will evaluate dynamic pain (passive elevation of the leg at 15°) using the Numeric Rating Scale (0-10), 6 hours, 12 hours and 24 hours after spinal anesthesia.

Being tested
Ropivacaine + saline solution, Saline solution + Ropivacaine

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ropivacaine + saline solutionDrug

    Also called Naropin + saline solution

    SIFIB with 30 ml of 0.5% ropivacaine and PENG Block plus LFCNB with 20 ml and 10 ml of saline solution, respectively.

  • Saline solution + RopivacaineDrug

    Also called Saline solution + Naropin

    SIFIB with 30 ml of saline solution and PENG Block plus LFCNB with 20 ml and 10 ml of 0,5% ropivacaine, respectively.

Study groups in NCT05749367
Study groupRoleWhat they receive
Suprainguinal Fascia Iliaca Block GroupActive comparatorPatients will undergo SIFIB with ropivacaine and PENG plus LFCNB with saline solution.
Receives: Drug: Ropivacaine + saline solution
PENG Block + Lateral Femoral Cutaneous Nerve Block GroupExperimentalPatients will undergo SIFIB with saline solution and PENG plus LFCNB ropivacaine.
Receives: Drug: Saline solution + Ropivacaine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Dynamic Post-op Hip Pain

    To assess dynamic hip pain (passive leg elevation at 15°) in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from (no pain) to 10 (worst possible pain).

    Measured: 6 hours after spinal anesthesia.

  2. Dynamic Post-op Hip Pain

    To assess dynamic hip pain (passive leg elevation at 15°) in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from (no pain) to 10 (worst possible pain).

    Measured: 12 hours after spinal anesthesia

  3. Dynamic Post-op Hip Pain

    To assess dynamic hip pain (passive leg elevation at 15°) in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from (no pain) to 10 (worst possible pain).

    Measured: 24 hours after spinal anesthesia

Secondary outcomes (8)
  1. Post-op Hip Pain at Rest

    To evaluate hip pain at rest in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from ) (no pain) to 10 (worst possible pain)..

    Measured: 6 hours, 12 hours and 24 hours after spinal anesthesia.

  2. Quadriceps muscle strength measured by dynamometry in newton (N).

    To test the quadriceps muscle strength by dynamometry (Med Force hand-held push dynamometer, tHHD, MED.DOR Ltd., Governador Valadares, Brazil) in newton.

    Measured: 6 hours, 12 hours and 24 hours after spinal anesthesia.

  3. Quadriceps muscle strength index

    To calculate quadriceps muscle strength index by the ratio between the strengths (collected by dynamometry) of the non-operated and operated lower limbs.

    Measured: 6 hours, 12 hours and 24 hours after spinal anesthesia.

  4. Total intravenous morphine dose in milligram over 24 hours

    To quantify the total rescue morphine dose (or morphine equivalent) in mg over 24h.

    Measured: 24 hours

  5. Time of the first morphine order in minutes

    To record the time of the first morphine order in minutes after the spinal anesthesia

    Measured: 24 hours

  6. Incidence of opioid side effects

    To record the incidence of opioid side effects - nausea/vomiting, pruritus, urinary retention and respiratory depression

    Measured: 24 hours

  7. Incidence of blockades complications

    To record the incidence of blockades complications - vascular puncture, hematoma, local anesthetic toxicity and nerve injury.

    Measured: 24 hours

  8. Incidence of delirium

    To evaluate altered cognition and conclude as positive or negative.

    Measured: 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Mar 2023
  2. Study start6 Mar 2023 (estimated)
  3. Primary completion10 Oct 2023 (estimated)
  4. Study completion10 Oct 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Prospective, controlled, randomized and double blind
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
66 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05749367
Sponsor's protocol ID
CAAE:42438721.1.0000.5129
Status last verified
Feb 2023
First submitted
8 Feb 2023
Last updated
1 Mar 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.

    PubMed 30063657
  • Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020 Nov 25;11(11):CD001159. doi: 10.1002/14651858.CD001159.pub3.

    PubMed 33238043
  • Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin. 2018 Sep;36(3):403-415. doi: 10.1016/j.anclin.2018.04.001. Epub 2018 Jul 11.

    PubMed 30092937
  • Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med. 2019 Feb 22:rapm-2018-100092. doi: 10.1136/rapm-2018-100092. Online ahead of print.

    PubMed 30798268
  • Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H, Van de Velde M. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med. 2017 May/Jun;42(3):327-333. doi: 10.1097/AAP.0000000000000543.

    PubMed 28059869
  • Morrison C, Brown B, Lin DY, Jaarsma R, Kroon H. Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review. Reg Anesth Pain Med. 2021 Feb;46(2):169-175. doi: 10.1136/rapm-2020-101826. Epub 2020 Oct 27.

    PubMed 33109730
  • Aliste J, Layera S, Bravo D, Jara A, Munoz G, Barrientos C, Wulf R, Branez J, Finlayson RJ, Tran Q. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med. 2021 Oct;46(10):874-878. doi: 10.1136/rapm-2021-102997. Epub 2021 Jul 20.

    PubMed 34290085
  • Lin DY, Morrison C, Brown B, Saies AA, Pawar R, Vermeulen M, Anderson SR, Lee TS, Doornberg J, Kroon HM, Jaarsma RL. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Reg Anesth Pain Med. 2021 May;46(5):398-403. doi: 10.1136/rapm-2020-102315. Epub 2021 Feb 26.

    PubMed 33637625
  • Macedo MC, Souza MA, Ferreira KR, Campos LO, Souza ISO, Barbosa MA, Brito CJ, Intelangelo L, Barbosa AC. Validity and Test-Retest Reliability of a Novel Push Low-Cost Hand-Held Dynamometer for Knee Strength Assessment during Different Force Ranges. Diagnostics (Basel). 2022 Jan 13;12(1):186. doi: 10.3390/diagnostics12010186.

    PubMed 35054353

Questions about this trial

What is this clinical trial studying?

A study testing Ropivacaine + saline solution and Saline solution + Ropivacaine in people with Anesthesia, Conduction, run by Federal University of Minas Gerais at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 1 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Leonardo SG Oliveira, MD (55 31988870672, saraivaleo@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Dynamic Post-op Hip Pain (time frame: 6 hours after spinal anesthesia.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05749367, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Mar 2023; AzTrials last refreshed its copy on 7 Nov 2026.

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