NCT07467356

Anterior Iliopsoas Space Block Versus PENG Block on Ease of Positioning for Spinal Anathesia in Patients Undergoing Hip Surgeries

Impact of Anterior Iliopsoas Space Block Versus PENG Block on Ease of Positioning for Spinal Anathesia in Patients Undergoing Hip Surgeries ;Randomized Clinical Trial

• Status: Recruiting
• Phase: Phase 3
• Study type: Interventional
• Enrollment: 90 (estimated)
• Sponsor: Benha University · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Total hip arthroplasty (THA) has been one of the most significant advancements in orthopedic surgery over the past century. hip fractures are typically associated with severe pain, effective analgesia is crucial both before and after surgery.Spinal anesthesia (SA) is the most commonly employed method of anesthesia for repairing these fractures.The anterior iliopsoas space block is a considered as a novel technique that targets the lumbosacral trunk as it passes beneath the psoas major muscle, offering potential advantages over the traditional sacral plexus block, which is performed in the supine position.

Detailed description

Total hip arthroplasty (THA) has been one of the most significant advancements in orthopedic surgery over the past century. hip fractures are typically associated with severe pain, effective analgesia is crucial both before and after surgery. Consequently, efforts are made to facilitate enhanced recovery profiles to reduce postoperative pain in THA patients. At present, multimodal analgesia approaches have been used for pain management after THA, including oral analgesia, epidural analgesia, and peripheral nerve block. Spinal anesthesia (SA) is the most commonly employed method of anesthesia for repairing these fractures. The intense pain resulting from the fracture can impede the optimal positioning required for these procedures , rendering access to the subarachnoid space challenging. Suboptimal postoperative analgesia may restrict limb mobility, consequently delaying recovery and increasing opioid consumption. Therefore, it is imperative to establish effective perioperative analgesia strategies that not only reduce the reliance on opioids but also mitigate their adverse effects, particularly in this patient population . Based on previous anatomical studies, it has been established that the articular branches of the femoral nerve, the obturator nerve, and the accessory obturator nerve (AON) play a crucial role in innervating the anterior hip capsule. Consequently, these nerves are identified as the primary targets for hip analgesia, and their effective blockade can be achieved through the peri-capsular nerve group (PENG) technique . Recently, The anterior iliopsoas space block is a considered as a novel technique that targets the lumbosacral trunk as it passes beneath the psoas major muscle, offering potential advantages over the traditional sacral plexus block, which is performed in the supine position.

Conditions

• Pain Management

Interventions

Type	Name	Description
DRUG	Bupivacaine	The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, "LOGIQ E") will be initially placed in a transverse plane over the anterior superior iliac spine (ASIS) and then alignes to identify the following landmarks: Anterior inferior iliac spine, ilio-pubic eminence, iliopsoas muscle and tendon, the femoral artery, and Pectineus muscle. Point of injection will be musculo-fascial plane between the psoas tendon and ilio-pubic eminence.
DRUG	Bupivacaine	placing a patient supine, identifying the anterior superior iliac spine and iliac crest, the skin of the block region will be cleaned with 5% povidone iodine followed by 70% ethyl alcohol .Both the sterile window sheets and probe will be covered with sterile drapes. A standardised amount of local anaesthetic will be administered utilising ultrasound guidance and a portable ultrasound system (General Electric; GE, "LOGIQ P5")to visualize the iliopsoas muscle in a transverse or longitudinal scan. The needle is advanced in-plane to the fascial plane between the iliopsoas muscle and the iliofemoral ligament or iliac bone, and local anesthetic is injected to spread along the iliopsoas muscle.

Timeline

• Start date: 2026-03-15
• Primary completion: 2026-08-15
• Completion: 2026-09-15
• First posted: 2026-03-12
• Last updated: 2026-03-12

Locations

1 site across 1 country: Egypt