What this Trial Is About

Researchers are evaluating pain management techniques for patients undergoing total hip replacement surgery due to hip osteoarthritis. This trial compares two methods of local anesthetic delivery: a total periarticular local anesthetic infiltration (PAI) versus a combination of posterior periarticular infiltration plus a low-volume ultrasound-guided pericapsular nerve group block (PENGB). The goal is to find a method that preserves muscle strength while providing effective pain relief during the first 24 hours after surgery. During surgery, patients receive either the full dose of anesthetic (60 mL of 0.25% bupivacaine with epinephrine and ketorolac) infiltrated around the joint or a partial dose (45 mL total, with 15 mL to the posterior periarticular area and 30 mL to fascia, subcutaneous tissue, and skin) combined with a 10 mL ultrasound-guided nerve block using 0.5% bupivacaine and epinephrine. All patients receive spinal anesthesia with bupivacaine and fentanyl, along with additional medications including tranexamic acid, ketoprofen, acetaminophen, and morphine administered via patient-controlled analgesia. Participants will be closely monitored from surgery through recovery and the first postoperative day. Assessments include measuring muscle strength at 3 hours after arrival to the post-anesthesia care unit to detect quadriceps motor weakness. Pain control, medication use, and side effects will also be evaluated. Outcome assessors blinded to treatment groups will perform measurements to ensure unbiased results. The total participation includes the surgery day and postoperative care during hospitalization.

Total Periarticular Infiltration Vs Posterior Periarticular Infiltration Plus PENG Block for Hip Analgesia