Pericapsular nerve group (PENG) block compared to intrathecal morphine for analgesic efficacy in total hip arthroplasty: A placebo-controlled randomized double-blind non-inferiority trial

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-07-02 DOI:10.1016/j.jclinane.2025.111921

Krešimir Oremuš , Vladimir Trkulja , Giorgina Gasparini , Siniša Šoštarić , Nikola Čičak , Miroslav Hašpl , Slobodan Mihaljević

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引用次数: 0

Abstract

Background

We hypothesized that pericapsular nerve group (PENG) block was non-inferior to intrathecal (IT) morphine regarding analgesia after total hip arthroplasty (THA) with no untoward effects on the motor function.

Methods

In a double-blind placebo-controlled non-inferiority trial, patients undergoing unilateral THA under spinal anesthesia were randomized to receive a PENG block (20 mL 0.5 % levobupivacaine +2 mg dexamethasone) or IT morphine (100 μg). They received multimodal oral postoperative analgesia with rescue intravenous morphine for breakthrough pain, and were repeatedly evaluated for pain over the first 48 postoperative hours using a 0–10 numerical rating scale (NRS), and for the straight leg raise test at 4, 6 and 12 h. Co-primary outcomes were (i) maximum pain at rest and (ii) at active hip flexion – estimated for the overall period based on three consecutive scores – and (iii) milligram morphine equivalents (MME) delivered over 48 h. Non-inferiority margins for the PENG block – IT morphine differences were 0.75 NRS points for the pain scores, and 10 for the cumulative MME (corresponds to one 4 mg intravenous morphine rescue dose).

Results

All randomized patients (N = 60, 1:1 ratio) completed all trial procedures. PENG block – IT morphine differences in the maximum pain at rest (difference = 0.182, 95 %CI -0.218 to 0.582) and at hip flexion (difference = −0.270, 95 %CI -0.990 to 0.453) were well below 0.75 NRS points, and the difference in MME (difference = −2.1, 95 %CI -6.5 to 1.9) was well below 10 MME. Age-adjusted straight leg raise test failure rates were similar in the two groups (11.7 % vs. 12.8 %, difference = −1.1, 95 %CI -9.7 to 7.5).

Conclusion

Compared to IT morphine, PENG block provides non-inferior analgesia after THA under spinal anesthesia without additional compromise of the motor function.

Trial registration number: NCT05308420

查看原文本刊更多论文

全髋关节置换术中囊周神经阻滞与鞘内吗啡镇痛效果的比较：一项安慰剂对照随机双盲非劣效性试验

背景：我们假设在全髋关节置换术（THA）后的镇痛方面，囊周神经阻滞（PENG）不低于鞘内吗啡（IT），对运动功能没有不良影响。方法在一项双盲安慰剂对照非效性试验中，脊髓麻醉下单侧THA患者随机接受PENG阻滞（20 mL 0.5%左布比卡因+2 mg地塞米松）或IT吗啡（100 μg）。对于突破性疼痛，患者接受了多模式口服术后镇痛并静脉注射吗啡，并在术后前48小时内使用0-10数值评定量表（NRS）反复评估疼痛，并在4时进行直腿抬高测试。6和12小时。共同的主要结局是(i)休息时最大疼痛和（ii）活动髋关节屈曲时的疼痛——基于三个连续评分来估计整个期间的疼痛——以及（iii） 48小时内递送的吗啡当量毫克（MME）。PENG阻断- IT吗啡的非效度差值为疼痛评分0.75 NRS点，累积MME值为10（相当于一个4 mg静脉注射吗啡抢救剂量）。结果所有随机患者（N = 60，比例为1:1）均完成了所有试验程序。彭块——它吗啡差异最大痛苦静止(差异= 0.182,95%可信区间-0.218到0.582),在髋关节屈曲(差异=−0.270,95%可信区间-0.990到0.453)低于0.75评分量表分、和居里夫人的差异(差异=−2.1,95%可信区间-6.5到1.9)远低于10杜洛瓦年龄调整直腿提高考试失败率在两组相似(11.7%比12.8%,差异=−1.1,95%可信区间-9.7到7.5)。结论与IT吗啡相比，彭阻滞可提供脊柱麻醉下THA术后非亚效性镇痛，且不损害运动功能。试验注册号：NCT05308420

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.