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AzTrials

PENG BlockNCT07263932

PENG vs PHPB for Hip Arthroplasty Analgesia

An observational study of PENG Block and Hip Arthroplasty, Total, run by Ankara City Hospital Bilkent at 1 site in Turkey (Türkiye).

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Total hip arthroplasty (THA) is a commonly performed surgical procedure, and its incidence continues to rise with the aging population. Effective postoperative analgesia facilitates early mobilization and accelerates recovery. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
PENG Block, Hip Arthroplasty, Total, QoR-15
What is being tested?
PENG Block and Posterior Hip Pericapsular Block and PENG Block
How many people
127 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Dec 2025to 1 Jul 2026
How long will I take part?
2 Days
Phase
Observational
Are there results?
Not yet: the study is under way

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

Study population: Adult patients aged 18 years and older, classified as ASA physical status I-II, scheduled for elective total hip arthroplasty under spinal anesthesia at Ankara Bilkent City Hospital. A total of 132 patients who meet the inclusion criteria and provide written informed consent will be enrolled in this single-center, prospective, randomized controlled trial.

Who may be able to join

  • Patients scheduled for elective total hip arthroplasty (THA) under spinal anesthesia
  • ASA physical status I-II
  • Age ≥18 years
  • Body Mass Index (BMI) between 18-35 kg/m²
  • Patients who provide written informed consent

Who cannot join

  • Age <18 years
  • ASA physical status ≥III
  • Known allergy or contraindication to study medications (local anesthetics, opioids, etc.)
  • Severe cardiac, renal, hepatic, or pulmonary failure
  • Revision total hip arthroplasty
  • Coagulopathy or anticoagulant use
Show all 18Show fewer
  • Local infection or neuropathic findings at the injection site
  • Chronic inflammatory diseases or chronic corticosteroid use
  • Diagnosed neuropsychiatric disorders
  • Pregnancy or lactation
  • Inability or unwillingness to read, understand, or sign the informed consent form
  • Obesity (BMI >35 kg/m²)
  • Failed spinal anesthesia or conversion to general anesthesia
  • Active malignancy or patients receiving radiotherapy/chemotherapy
  • Active systemic infection or ongoing antibiotic therapy (except prophylaxis)
  • Contraindication to regional anesthesia techniques
  • Chronic opioid or analgesic use for pain disorders
  • History of intracranial mass, increased intracranial pressure, epilepsy, cerebrovascular accident, neuromuscular disease, or motor/sensory deficits

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Ankara Bilkent City Hospital Departmant of Anesthesiology and Reanimation, Ankara,Çankaya

    Ankara, Çankaya, 06800

Other trials in Turkey (Türkiye)

About this study

Official title: Postoperative Analgesic Effectiveness of Pericapsular Nerve Block (PENG) and Posterior Hip Pericapsular Block (PHPB) in Hip Arthroplasty

Total hip arthroplasty (THA) is a commonly performed surgical procedure, and its incidence continues to rise with the aging population. Effective postoperative analgesia facilitates early mobilization and accelerates recovery. The pericapsular nerve group (PENG) block provides analgesia to the anterior hip capsule by targeting the articular branches of the femoral, obturator, and accessory obturator nerves. However, due to the contribution of sacral plexus-derived nerves (quadratus femoris, superior gluteal, and inferior gluteal nerves) to posterior hip pain, anterior blocks alone may be insufficient.

This prospective study aims to compare the efficacy of preoperatively administered PENG block alone versus the combination of PENG and posterior hip pericapsular block (PHPB) in postoperative pain control after total hip arthroplasty. The primary outcome is postoperative pain intensity assessed by the Numerical Rating Scale (NRS). Secondary outcomes include the Quality of Recovery score (QoR-15), opioid consumption, manual muscle testing (MMT) results, time to mobilization, and block-related complications.

Read the detailed description

Total hip arthroplasty (THA) is a widely performed surgical procedure, and its incidence continues to increase with the aging population. It is an effective intervention to improve the quality of life in patients with advanced osteoarthritis or rheumatoid arthritis. Postoperative pain is one of the most common complications following THA. Effective postoperative analgesia facilitates early mobilization and accelerates recovery. Early mobilization within the first 24 hours after surgery has been shown to significantly reduce the length of hospital stay.

Regional anesthesia techniques for postoperative analgesia in hip surgery play a crucial role in pain management and recovery. International pain management guidelines recommend multimodal analgesic protocols for elective total hip arthroplasty, emphasizing the role of peripheral nerve blocks as part of these strategies.

Current anatomical studies have demonstrated that the innervation of the hip joint capsule is derived from multiple nerves originating from the lumbosacral plexus. The density and distribution of this neural supply may vary among individuals depending on pelvic morphology, ethnicity, and sex. The anterior portion of the hip joint capsule is primarily innervated by articular branches of the femoral and obturator nerves, while the posterior aspect receives innervation from branches of the sciatic nerve, the superior gluteal nerve, and the nerve to quadratus femoris (NQF). The NQF, which provides significant sensory input to the posterior hip region, has become a key anatomical target for posterior hip-focused regional anesthesia techniques.

The pericapsular nerve group (PENG) block, first described by Girón-Arango et al., provides analgesia to the anterior hip capsule by blocking the articular branches of the femoral, obturator, and accessory obturator nerves. PENG block has been suggested to facilitate early mobilization and recovery compared to other anterior approaches. However, even with appropriate anterior blocks, posterior gluteal pain may persist in patients with hip pathology. This highlights the potential importance of targeting sacral plexus-derived nerves for comprehensive analgesia.

Recent research has shown that branches from the quadratus femoris nerve (NQF), superior gluteal nerve (SGN), and inferior gluteal nerve (IGN) contribute to the posterior capsule innervation of the hip joint. Regional anesthesia techniques targeting these posterior articular branches may enhance postoperative analgesia, promote early mobilization, and improve functional recovery. Consequently, the integration of sacral plexus-focused posterior blocks alongside anterior approaches is increasingly being emphasized in multimodal analgesia protocols for THA.

The combination of the posterior hip pericapsular block (PHPB) with the PENG block has been reported to provide balanced and effective analgesia across the entire hip capsule while preserving motor function.

The aim of this prospective study is to compare the efficacy of preoperatively administered PENG block alone versus the combination of PENG and posterior hip pericapsular block (PHPB) for postoperative pain control in patients undergoing total hip arthroplasty. The primary endpoint is postoperative pain intensity assessed using the Numerical Rating Scale (NRS). Secondary endpoints include the Quality of Recovery (QoR-15) score, opioid consumption, manual muscle testing (MMT) results, time to mobilization, and block-related complications.

Being tested
PENG Block and Posterior Hip Pericapsular Block, PENG Block

What participants receive

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

  • PENG Block and Posterior Hip Pericapsular BlockProcedure or surgery

    Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule. In addition to the PENG block, a Posterior Hip Pericapsular Block (PHPB) will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The local anesthetic will be injected between the piriformis muscle and the ischiofemoral ligament to target the posterior articular branches of the quadratus femoris, superior gluteal, and inferior gluteal nerves. The combined PENG + PHPB approach aims to provide comprehensive analgesia of both the anterior and posterior hip capsule while preserving motor function.

  • PENG BlockProcedure or surgery

    Patients in this group will also undergo elective total hip arthroplasty (THA) under spinal anesthesia.A preoperative Pericapsular Nerve Group (PENG) block will be performed under ultrasound guidance using 20 mL of 0.25% bupivacaine. The injection will be administered between the psoas tendon and the iliac bone to block the articular branches of the femoral, obturator, and accessory obturator nerves, providing analgesia to the anterior hip capsule.

Study groups in NCT07263932
Study groupRoleWhat they receive
PENG GroupThe group that will receive the preoperative Pericapsular Nerve Group (PENG) block
Receives: Procedure: PENG Block
PENG + PHPB GroupThe group that will receive the preoperative Pericapsular Nerve Group (PENG) block and Posterior Hip Pericapsular Block (PHPB)
Receives: Procedure: PENG Block and Posterior Hip Pericapsular Block

What is being measured

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

  1. Postoperative pain

    Postoperative pain will be assessed using the Numeric Rating Scale (NRS; 0 = no pain, 10 = worst imaginable pain) at rest and during movement at 0, 2, 6, 8, 12, 24, 36, and 48 hours after surgery. The NRS scores will be compared between the two study groups (PENG vs. PENG + PHPB) to evaluate the effectiveness of the blocks in postoperative analgesia following total hip arthroplasty.

    Measured: Up to 48 hours postoperatively

Secondary outcomes (5)
  1. QUALİTY OF RECOVERY-15

    The quality of postoperative recovery will be assessed using the validated 15-item Quality of Recovery questionnaire (QoR-15). The total score ranges from 0 (very poor recovery) to 150 (excellent recovery). The score will be measured preoperatively and at 24 and 48 hours postoperatively to compare recovery quality between the two groups.

    Measured: Preoperative, 24, and 48 hours postoperatively

  2. MANUEL MUSCLE TEST

    Quadriceps muscle strength will be evaluated using the Manual Muscle Test (MMT) scale at 6, 12, and 24 hours after surgery. The MMT scale ranges from 0 (no contraction) to 5 (normal strength). A score <3 indicates quadriceps weakness.

    Measured: 6, 12, and 24 hours postoperatively

  3. Rescue analgesic

    The time from the end of surgery to the patient's first request for rescue analgesia will be recorded. Rescue analgesia consists of intravenous tramadol 100 mg administered if the Numeric Rating Scale (NRS) score is ≥ 4. This measure will compare the analgesic duration provided by the two blocks (PENG vs. PENG + PHPB).

    Measured: 0-48 hours postoperatively

  4. Postoperative Nausea and Vomiting (PONV)

    The presence of postoperative nausea and/or vomiting will be recorded during the first 48 hours following surgery.

    Measured: 0-48 hours postoperatively

  5. Length of Hospital Stay

    The duration of hospitalization will be measured from the day of surgery to discharge.

    Measured: Up to discharge (approximately 3-5 days postoperatively)

Timeline

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

  1. First posted4 Dec 2025
  2. Study start1 Dec 2025
  3. Primary completion15 Apr 2026
  4. Study completion1 Jul 2026 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
127 participants (actual)
Target duration
2 Days
IDs, dates and publications
ClinicalTrials.gov ID
NCT07263932
Sponsor's protocol ID
E2-25-12993
Status last verified
Oct 2025
First submitted
24 Nov 2025
Last updated
6 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Atalay YO, Ciftci B, Tekin B, Ansen G, Sakul BU, Cacan MA, Azboy I, Yilmaz B, Alici HA. A Case Series of Deep Subgluteal Block: A New Block Targeting the Missed Portion of the Hip for Analgesia After Total Hip Replacement. A A Pract. 2024 Sep 9;18(9):e01848. doi: 10.1213/XAA.0000000000001848. eCollection 2024 Sep 1.

    PubMed 39250338
  • Duan L, Li J, Chen Z, Wen T, He J, Zhang A. Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series. BMC Anesthesiol. 2024 Oct 1;24(1):352. doi: 10.1186/s12871-024-02731-2.

    PubMed 39354374
  • Vermeylen K, Van Aken D, Versyck B, Casaer S, Bleys R, Bracke P, Groen G. Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study. BJA Open. 2023 Feb 15;5:100127. doi: 10.1016/j.bjao.2023.100127. eCollection 2023 Mar.

    PubMed 37587997

Questions about this trial

What is this clinical trial studying?

An observational study of PENG Block and Hip Arthroplasty, Total, run by Ankara City Hospital Bilkent at 1 site in Turkey (Türkiye).

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 5 inclusion and 18 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: under way, not looking for participants, as of the sponsor's last update on 6 May 2026. 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 Turkey (Türkiye). 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?

This study is still under way. Results are not available in the source record yet.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postoperative pain (time frame: Up to 48 hours postoperatively). 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 NCT07263932, which also lists 3 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 6 May 2026.

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