QLESP Block Versus PENG+LFCN Block for Total Hip Arthroplasty

Huazhong University of Science and Technology136 enrolled

Overview

Total hip arthroplasty (THA) is a common surgery to replace damaged hip joints, but many patients experience significant pain after surgery, which can delay recovery and increase the need for strong pain medications (opioids). Nerve blocks are a technique where anesthetic medication is injected near specific nerves to reduce pain. This study compares two different ultrasound-guided nerve block techniques for pain control after THA: the QLESP block (a newer technique that targets two areas with a single injection) and the PENG block combined with the LFCN block (a currently used technique that targets nerves around the hip joint and the outer thigh). Participants in this study will be randomly assigned (like a coin flip) to receive either the QLESP block or the PENG+LFCN block after surgery. The study aims to determine which nerve block provides better pain relief and reduces the need for opioid pain medications in the first 24 hours after surgery. Pain scores, recovery of leg movement, time to first walk, length of hospital stay, and any side effects will also be compared between the two groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

136

Conditions

Pain Management Arthroplasty Total Hip Replacement

Interventions

QLESP BlockPROCEDURE

Ultrasound-guided quadratus lumborum and modified erector spinae plane block. A single-puncture, dual-injection technique at the L4 level. Total volume: 30 mL of 0.375% ropivacaine.

PENG+LFCN BlockPROCEDURE

Ultrasound-guided pericapsular nerve group block combined with lateral femoral cutaneous nerve block. PENG: 20 mL of 0.375% ropivacaine; LFCN: 10 mL of 0.375% ropivacaine.

ropivacaineDRUG

Ropivacaine hydrochloride injection, 0.375% solution, administered as a single dose via ultrasound-guided nerve block. Total dose: 112.5 mg (30 mL of 0.375% solution) for the QLESP group; 112.5 mg (30 mL of 0.375% solution) for the PENG+LFCN group.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 to 70 years * Scheduled for elective unilateral total hip arthroplasty via posterolateral approach * American Society of Anesthesiologists (ASA) physical status I-III * Body mass index (BMI) \< 35 kg/m² * Ability to understand pain scoring and patient-controlled analgesia (PCA) use * Willing and able to provide written informed consent Exclusion Criteria: * Allergy or hypersensitivity to local anesthetics (ropivacaine) * Long-term opioid use or chronic pain history requiring regular analgesic use * Active malignancy or infection at the puncture site * Severe psychiatric disorders or communication barriers * Severe cardiopulmonary disease * History of opioid abuse or substance dependence * Participation in another interventional clinical trial within 3 months prior to enrollment * Coagulation abnormalities * Pregnancy or breastfeeding * Any condition that, in the investigator's opinion, would compromise patient safety or data integrity

Outcomes

Primary Outcomes

Postoperative 24-Hour Cumulative Opioid Consumption

Time frame: At 24 hours after surgery

Secondary Outcomes

Postoperative VAS Pain Scores

The Visual Analogue Scale (VAS) is a 10-cm line ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate worse pain. Pain scores are assessed at rest and during movement (passive hip flexion to 15 degrees) at each time point.

Time frame: At 6, 12, 24, 36, and 48 hours after surgery

Rescue Analgesia Requirement

Time frame: Within 24 hours after surgery

Motor Block Assessment (Bromage Score)

The Bromage Score is a 4-point scale ranging from 0 (no motor block, able to perform full knee flexion and foot dorsiflexion against resistance) to 3 (complete motor block, unable to move knee or foot). Higher scores indicate worse motor function. Assessed on the operative side at each time point. A score of 0-1 is considered clinically acceptable for early ambulation.

Time frame: At 6, 24, and 48 hours after surgery

Time to First Ambulation

Time frame: From surgery end to first walk, up to 7 days

Length of Hospital Stay

Time frame: From surgery date to discharge, up to 30 days

Incidence of Adverse Events

Time frame: From surgery end to 48 hours after surgery