MRI-Based Assessment of Local Anesthetic Spread in the PENG Block Compartment
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: PENG Block, Magnetic resonance imaging.
- Who it may be relevant to
- Registry conditions: Total Hip Arthroplasty (THA), Postoperative Pain Management After Total Hip Arthroplasty. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Italy
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Evaluation of Local Anesthetic Distribution in the PENG Block Compartment Using Pelvic MRI
Overview
This study uses MRI imaging to evaluate the spread of local anesthetic following the administration of a pericapsular nerve group (PENG) block. The goal is to determine whether a distinct fascial plane exists between neurovascular structures, potentially explaining the block's observed clinical effectiveness.
Detailed description
The pericapsular nerve group (PENG) block has demonstrated promising clinical results in providing analgesia for hip-related pain, particularly in patients with femoral neck fractures or undergoing hip surgery. However, the exact mechanism of action and spread of local anesthetic remain poorly understood. This pilot study aims to use magnetic resonance imaging (MRI) to visualize the distribution pattern of the injectate after PENG block administration.
High-resolution MRI scans will be obtained shortly after the procedure to assess the spatial relationship between the spread of local anesthetic, relevant anatomical structures (including the iliopsoas muscle, femoral artery, and femoral nerve), and potential fascial compartments. The findings will help to clarify the anatomic basis of the PENG block and may guide optimization of technique for enhanced clinical outcomes.
Interventions
- Procedure PENG Block
Preoperative ultrasound giuded PENG block (ropivacaine 0,5% 20mL) - Procedure Magnetic resonance imaging
The patient will undergo a pelvic MRI to assess anesthetic diffusion after PENG block
Primary outcome measures
- Extent of local anesthetic spread as visualized on MRI after PENG block administration [Time frame: 10 minutes after injection]
Eligibility criteria
Inclusion criteria
- Patients scheduled for total hip replacement surgery
- Age ≥ 18 years
- ASA physical status classification I-III
- Signed informed consent obtained
- Orthopedic indication for preoperative MRI study
Exclusion criteria
- Allergy to local anesthetics
- Infection at the planned puncture site
- Refusal or inability to provide informed consent
- Age < 18 years
- Claustrophobia
- Altered consciousness or severe dementia
- Presence of MRI-incompatible implanted devices (e.g., pacemakers implanted before 2000)
- Pregnancy or breastfeeding
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Supportive care
Study locations
Italy · 1 center
- Policlinico Universitario Campus Bio-Medico — Roma
Publications
- Gargano F, Migliorelli S, Pascarella G, Costa F, Strumia A, Bellezze A, Ruggiero A, Carassiti M. A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block. Minerva Anestesiol. 2025 Jun;91(6):524 PMID 39656148
- Nielsen ND, Greher M, Moriggl B, Hoermann R, Nielsen TD, Borglum J, Bendtsen TF. Spread of injectate around hip articular sensory branches of the femoral nerve in cadavers. Acta Anaesthesiol Scand. 2018 Aug;62(7):1001-1006. doi: 10.1111/aas.13122. Epub 2018 Apr 17. PMID 29664158
- Pascarella G, Costa F, Del Buono R, Pulitano R, Strumia A, Piliego C, De Quattro E, Cataldo R, Agro FE, Carassiti M; collaborators. Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia. 2021 Nov;76(11):1492-1498. doi: 10.1111/anae.15536. Epub 2021 Jul 1. PMID 34196965
- Sakamoto J, Manabe Y, Oyamada J, Kataoka H, Nakano J, Saiki K, Okamoto K, Tsurumoto T, Okita M. Anatomical study of the articular branches innervated the hip and knee joint with reference to mechanism of referral pain in hip joint disease patients. Clin Anat. 2018 Jul;31(5):705-709. doi: 10.1002/ca.23077. Epub 2018 Apr 16. PMID 29577432
- Lee DJ, Elfar JC. Timing of hip fracture surgery in the elderly. Geriatr Orthop Surg Rehabil. 2014 Sep;5(3):138-40. doi: 10.1177/2151458514537273. PMID 25360345
Identifiers
NCT: NCT07040423 · Policlinico Campus Bio-Medico