PENG Block vs Suprainguinal FICB vs Lumbar ESPB for Analgesia After Hip Surgery

Summary

This randomized, double-blinded, controlled clinical trial compares three motor-sparing regional anesthesia techniques used for postoperative analgesia in patients undergoing hip arthroplasty: the Pericapsular Nerve Group (PENG) block, the suprainguinal Fascia Iliaca Compartment Block (S-FICB), and the Lumbar Erector Spinae Plane Block (L-ESPB). Although all three techniques are widely used in modern hip surgery, their relative analgesic efficacy, opioid-sparing potential, and impact on early functional recovery have not been directly compared in a single study. The primary objective is to determine which block provides the most effective postoperative analgesia while preserving motor function and facilitating early mobilization. Secondary objectives include comparisons of opioid consumption, pain scores at rest and during movement, time to first rescue analgesia, block-related adverse events, quadriceps strength, incidence of postoperative nausea and vomiting, and early functional outcomes. This study aims to identify the optimal motor-sparing regional anesthesia strategy for older adults undergoing hip arthroplasty.

Eligibility

Inclusion Criteria:

* Adults aged 65 years or older scheduled to undergo elective hip arthroplasty under spinal anesthesia.
* Ability to provide written informed consent.
* Ability to understand and reliably use numerical pain assessment tools (NRS 0-10).
* ASA physical status II-III.
* Expected postoperative hospitalization of at least 48 hours to ensure complete data collection.

Exclusion Criteria:

* Inability to provide informed consent due to cognitive impairment, language barrier, or severe hearing/speech limitations.
* Coagulopathy or therapeutic anticoagulation not meeting safety criteria for regional anesthesia.
* Local infection at the planned block site.
* Allergy, hypersensitivity, or contraindication to ropivacaine, local anesthetics, or study medications.
* Pre-existing lower-limb neurological deficits (motor or sensory) affecting outcome assessments.
* Severe spinal deformity or anatomical limitations preventing safe performance of regional blocks.
* Chronic opioid use (defined as \>30 mg oral morphine equivalents daily for more than 2 weeks).
* Severe renal failure (eGFR \<30 mL/min/1.73m²) or severe hepatic impairment.
* Uncontrolled diabetes mellitus (fasting glucose \>300 mg/dL or HbA1c \>10%).
* History of local anesthetic systemic toxicity (LAST).
* Participation in another interventional clinical trial within the past 30 days.
* Any condition deemed by investigators to interfere with protocol adherence, safety monitoring, or outcome reliability.

Conditions2

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