Which Analgesia is Better for Proximal Femoral Fractures?

Mansoura University100 enrolled

Overview

This patient population is typically elderly and frail. They are at risk of adverse effects secondary to inadequate pain management such as prolonged admissions and poor functional outcomes. Regional analgesia is preferred due to their opioid-sparing effects and reduction in related adverse effects but The analgesia from these blocks is only moderate and literature suggests that the obturator nerve (ON) is not covered.

The aim of this study is to compare the effect of combined lateral femoral cutaneous nerve block with pericapsular nerve group block versus fascia iliaca block for proximal femur surgery. Fascia iliaca compartment block is a simple technique to manage pain before positioning for spinal anesthesia performance and it constitutes a practical choice for perioperative pain control. A recent anatomical study confirmed the innervation of the anterior hip by these 3 main nerves, but also found that the AON and FN play a greater role in the anterior hip innervation than previously reported The high articular branches from FN and AON are consistently found between the anterior inferior iliac spine (AIIS) and the iliopubic eminence (IPE), whereas the ON is located close to the inferomedial acetabulum. The ultrasound-guided technique for blockade of these articular branches to the hip, the PENG (Pericapsular Nerve Group) block reported significantly reduced pain scores compared with baseline. Roy et al 2019 recommended the use of PENG block together with LFCN block as adjunctive to cover the lateral surgical incision.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

100

Conditions

Proximal Femur Fracture

Interventions

Fascia iliaca blockPROCEDURE

A linear probe will be placed in the sagittal plane to the inguinal ligament to obtain an image of "bow-tie sign" formed by the muscle fascias, a spinal needle will be inserted 1 cm cephalad Using an in-plane approach, the fascia iliaca is penetrated, 30 mL of bupivacaine 0.25% before spinal anesthesia.

combined LFCN block with PENG blockPROCEDURE

With the patient supine, the linear probe is placed parallel to the inguinal ligament. LFCN appear as a hypoechoic oval structure between the tensor fascia lata and Sartorius muscles. The needle is inserted in plane. 5 mL of LA is injected. The PENG block will be performed in the supine position. A curvilinear probe will be placed transversely over the anterior inferior iliac spine and then rotated counterclockwise 45 degrees. the ilio pubic eminence, the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle will be observed. A spinal needle will be inserted in plane to the plane between the psoas tendon and the pubic ramus. 25 mL of bupivacaine 0.25% will be injected

Eligibility

Sex: ALLMin age: 50 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * American Society of Anesthesiologists (ASA) physical status I, II and III. Exclusion Criteria: * Patient refusal. * Neuromuscular diseases * Hematological diseases * Bleeding abnormality * Coagulation abnormality. * Psychiatric diseases. * Local skin infection at the site of the block. * Local skin sepsis at the site of the block * Known intolerance to the study drugs. * Body Mass Index \> 40 Kg/m2. * Multiple trauma patients.

Locations (1)

Mansoura University, emergency hospital

Al Mansurah, DK, Egypt

RECRUITING

Outcomes

Primary Outcomes

Time of performance of Spinal Anesthesia

Is defined as the time measured from the start of positioning to the completion of the intrathecal bupivacaine injection

Time frame: just before surgery.

Secondary Outcomes

Pain measurement at rest

10-cm visual analog scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain

Time frame: immediately and 1 hour at PACU, then in the surgical ward at 2,4,6,8,12,18 and 24 h after surgery.

Pain measurement on movement

(attempted hip flexion to 15 degrees).: 10-cm visual analog scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain

Time frame: immediately and 1 hour at PACU, then in the surgical ward at 2,4,6,8,12,18 and 24 h after surgery.

Pain measurement during positioning for spinal anesthesia

visual analog scale (0-10, 0: no pain, 10: worst pain imaginable) during changing position from supine to sitting one

Time frame: Just before surgery

The severity of postoperative pain at rest

10-cm visual analog scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain

Time frame: immediately and 1 hour at PACU, then in the surgical ward at 2,4,6,8,12,18 and 24 h after surgery.

The severity of postoperative pain on movement

(attempted hip flexion to 15 degrees): 10-cm visual analog scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain

Time frame: immediately and 1 hour at PACU, then in the surgical ward at 2,4,6,8,12,18 and 24 h after surgery.

Central Contacts

Mona A Hasheesh, MD

CONTACT

00201027034020 drmonahasheesh@hotmail.com

Eiad A Ramzy, MD

CONTACT

00201005774079 eiadramzy@yahoo.com

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.