Low-Volume Pericapsular Nerve Group (PENG) Block With Dexamethasone vs Standard-Volume PENG Block After Total Hip Arthroplasty

Summary

The goal of this clinical trial is to compare two regimens of the pericapsular nerve group (PENG) block, an ultrasound-guided injection of local anaesthetic targeting the nerves supplying the front of the hip joint, for postoperative pain relief and quadriceps muscle function in patients undergoing primary unilateral total hip arthroplasty under spinal anaesthesia. The PENG block was originally proposed as a motor-sparing technique. However, the standard 20 mL volume can spread to the femoral nerve and cause quadriceps weakness. Reducing the injected volume may limit this spread and better preserve quadriceps strength, but smaller volumes risk shorter analgesic duration. Adding dexamethasone to a low-volume injection may compensate for the reduced volume. The main questions this trial aims to answer are: * Does a low-volume PENG block (10 mL bupivacaine 0.25%) with 4 mg dexamethasone differ from a standard-volume PENG block (20 mL bupivacaine 0.25%) in the time to first rescue analgesia? * Does it differ in the incidence and severity of quadriceps weakness on the operated side? Researchers will compare: * Group A (standard-volume PENG block): 20 mL bupivacaine 0.25%. * Group B (low-volume PENG block with dexamethasone): 5 mL bupivacaine 0.5% plus 4 mL normal saline plus 4 mg dexamethasone in 1 mL, giving 10 mL of bupivacaine 0.25%. Participants will: * Receive spinal anaesthesia with heavy bupivacaine 0.5% and fentanyl. * Be randomly allocated to Group A or Group B using computer-generated random numbers. * Receive the PENG block under ultrasound guidance, performed by an anaesthesiologist expert in regional anaesthesia. * Receive intravenous paracetamol 1 g every 8 hours, with intravenous nalbuphine 5 mg as rescue analgesia when the pain score (NRS) is 4 or more. * Be assessed by an anaesthesiologist blinded to group allocation for pain scores at rest and on movement at 2, 6, 12 and 24 hours; quadriceps strength (MRC scale and straight leg raise) at 6, 12 and 24 hours compared with the preoperative baseline; total opioid consumption over the first 24 hours; and time to first ambulation within the first 24 hours. The primary outcome is the time from completion of the PENG block to the first administration of rescue analgesia, recorded over the first 24 hours postoperatively. The study will be conducted at Ain Shams University Hospitals (El Demerdash Hospital) and will include 60 patients (30 per group), aged 50 to 70 years, ASA physical status I or II.

Timeline

Start

2026-10-15

Primary completion

2027-08-31

Completion

2027-09-14

Publications

• Background Yu L, Shen X, Liu H. The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 Feb 24;10:1084532. doi: 10.3389/fmed.2023.1084532. eCollection 2023.
• Background 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.
• Background Balasubramaniam A, Kumar Naggaih S, Tarigonda S, Madhusudhana R. Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Study Comparing Ropivacaine and Ropivacaine With Dexamethasone. Cureus. 2023 Jan 27;15(1):e34261. doi: 10.7759/cureus.34261. eCollection 2023 Jan.
• Background Reysner T, Kowalski G, Mularski A, Pyszczorska M, Grochowicka M, Perek A, Daroszewski P, Reysner M. Perineural dexamethasone effectively prolongs anaesthesic block duration in total hip arthroplasty, reduces opioid consumption, and does not compromise motor function, nerve integrity, or glycaemic control. Int Orthop. 2025 Aug;49(8):1791-1799. doi: 10.1007/s00264-025-06578-1. Epub 2025 Jun 11.
• Background Reysner T, Neumann-Podczaska A, Pietraszek P, Mularski A, Kowalski G, Daroszewski P, Reysner M. Reduced Ropivacaine Volume with Perineural Dexamethasone in PENG Block for Total Hip Arthroplasty: A Randomized Controlled Trial. J Clin Med. 2025 Dec 9;14(24):8722. doi: 10.3390/jcm14248722.
• Background Zufferey PJ, Chaux R, Lachaud PA, Capdevila X, Lanoiselee J, Ollier E. Dose-response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. Br J Anaesth. 2024 May;132(5):1122-1132. doi: 10.1016/j.bja.2023.12.021. Epub 2024 Jan 27.
• Background Kim JY, Kim J, Kim DH, Han DW, Kim SH, Kim D, Chung S, Yu S, Lee UY, Park HJ. Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block. Anesth Analg. 2023 Mar 1;136(3):597-604. doi: 10.1213/ANE.0000000000006364. Epub 2023 Feb 17.
• Background Leurcharusmee P, Kantakam P, Intasuwan P, Malatong Y, Maikong N, Navic P, Kitcharanant N, Mahakkanukrauh P, Tran Q. Cadaveric study investigating the femoral nerve-sparing volume for pericapsular nerve group (PENG) block. Reg Anesth Pain Med. 2023 Nov;48(11):549-552. doi: 10.1136/rapm-2023-104419. Epub 2023 Apr 7.
• Background Yeoh SR, Chou Y, Chan SM, Hou JD, Lin JA. Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks. Healthcare (Basel). 2022 Aug 18;10(8):1565. doi: 10.3390/healthcare10081565.
• Background 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.

Drugs

Indications

No indication recorded.