This randomized, double-blinded, placebo-controlled trial seeks to evaluate the analgesic efficacy of the pericapsular nerve group block in the setting of outpatient hip arthroscopy.
The pericapsular nerve group, or PENG block, has been recently described and shows promise in providing analgesia to the hip joint. The analgesic value of this block in the setting of hip arthroscopy is unknown. This study aims to compare a preoperative PENG block to placebo block prior to outpatient hip arthroscopy under general anesthesia. The primary outcome measure is immediate postoperative pain as measured by numerical rating score in the post-anesthesia care unit (PACU). Secondary outcomes include opioid consumption, opioid-related adverse events, patient satisfaction, chronic opioid usage, and pain scores at other time points.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
70
Ultrasound-guided injection of 20 mL 0.5% ropivacaine according to the method described by Giron-Arango L in 2018. A needle is inserted at the inguinal level under ultrasound guidance to pass beneath the psoas tendon on top of the iliopubic eminence where the local anesthetic is injected.
Ultrasound-guided placebo injection of 5 mL 0.9% normal saline. Using the same landmarks as for the PENG group, a needle is inserted in the inguinal region under ultrasound guidance, whereby a subcutaneous injection of 5 mL of 0.9% saline is made.
20 mL 0.5% ropivacaine will be injected for the preop PENG block
UVA Outpatient Surgery Center
Charlottesville, Virginia, United States
PACU pain score
Maximum pain score within the first 30 minutes after emergence in the post-anesthesia care unit. Pain will be assessed by numerical rating score (0-10, where 0 is no pain, and 10 is the worst possible pain).
Time frame: Within 30 minutes of emergence from anesthesia.
PACU opioid consumption
Total morphine milligram equivalents required by patients in the post-anesthesia care unit, prior to discharge from the outpatient surgery center. Following emergence from anesthesia, pain will be assessed in regular intervals, with administration of IV and oral opioids according to numeric rating scale and clinical assessment. Opioid administration stops when patient numerical rating score is \<4, when patient endorses manageable pain level, when side effects of opioids are intolerable, or for other concerning clinical conditions as determined by the anesthesiologist of record.
Time frame: Beginning with emergence from anesthesia and ending with discharge from the post-anesthesia care unit (typically 2 hours).
Nausea and Vomiting
This is a yes/no binary outcome measure defined by administration of any antiemetic drug in the post-anesthesia care unit.
Time frame: Beginning with emergence from anesthesia and ending with discharge from the post-anesthesia care unit (typically 2 hours).
Patient satisfaction with analgesia
Patients will be called at 24 hours and 48 hours postoperatively. They will be asked during each call if they are satisfied with their pain control (binary - yes or no).
Time frame: Determined through follow-up calls at 24 hours and 48-hours.
Postoperative opioid utilization
Cumulative postoperative opioid consumption expressed in morphine milligram equivalents
Time frame: Determined through follow-up calls at 24 hours, 48 hours, and 1 week postoperatively
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5 mL 0.9% Normal saline will be injected for the Placebo block
Postoperative pain scores
Postoperative numerical rating scores after discharge (0-10, where 0 is no pain, and 10 is the worst possible pain).
Time frame: Determined through follow-up calls at 24 hours, 48 hours, and 1 week postoperatively