Comparative Study Between Pericapsular Nerve Group Block (PENG) And Pericapsular Nerve Group (PENG) Block Combined With Lateral Femoral Cutaneous Nerve (LFCN) Block for Positioning Analgesia Prior to Spinal Anesthesia in Hip Fracture Patients

Ain Shams University24 enrolled

Overview

To evaluate and compare the effectiveness of the Pericapsular Nerve Group (PENG) block alone versus the PENG block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block in providing adequate analgesia for patient positioning during spinal anesthesia in individuals undergoing surgery for hip fracture.

Hip fractures are common among adult patients and often necessitate urgent surgical intervention. Positioning these patients for spinal anesthesia in sitting position is often difficult due to intense pain from the fracture. PENG block is a novel regional technique that targets the articular branches of the femoral nerve, obturator nerve, and accessory obturator nerve, providing excellent anterior hip analgesia sparing the motor function. It is performed under ultrasound guidance and has shown promising results in perioperative pain management. By combining LFCN block with the PENG block, more complete sensory blockade may be achieved. The effectiveness of this combination has not yet been adequately studied, particularly regarding positioning for spinal anesthesia. Therefore, this trial aims to compare the analgesic efficacy of PENG block alone versus PENG +LFCN block in this specific context.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

Conditions

Hip Fracture Surgeries

PENG BlockPROCEDURE

Pericapsular Nerve Group Block

LCFN blockPROCEDURE

Lateral Femoral Cutaneous Nerve block

bupivacaine 0.25%.DRUG

0.25% of Bupivacaine (Bupivacaine 0.5% is added to Lidocaine 2% in the same volume)

Xylocaine 2 %DRUG

local infilteration at the insertion site

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18-70 years. * ASA I-II. * Confirmed primary unilateral hip fracture. * Scheduled for surgery under spinal anesthesia. * Patients able to provide informed consent. Exclusion Criteria: * Allergy to local anesthetics. * Coagulopathy or on anticoagulant therapy. * Infection at injection site. * Pre-existing neurological deficits in the lower limbs. * Multiple trauma or polytrauma (If other injuries might interfere with positioning or pain scoring). * Previous surgery on the ipsilateral hip affecting anatomy or nerve distribution.

Outcomes

Primary Outcomes

To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups

time taken in seconds for positioning for spinal anesthesia 15 minutes post- block

Time frame: from initiation of patient positioning until optimal positioning is achieved during the spinal anesthesia procedure

Secondary Outcomes

To assess Numerical Rating Pain Score in both groups at 0,5,10 and 15 minutes post block

It refers to the common method used in healthcare where patients rate their pain on a scale from 0 to 10 (0 = No pain 10 = Worst pain imaginable).

Time frame: at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block

To assess patient satisfaction and comfort during positioning using Likert scale

5-Point scale (1=strongly disagree and 5=strongly agree). The participants measure it 15 minutes post- block during positioning for spinal anesthesia

Time frame: during patient positioning 15 minutes after completion of the block

To monitor mean arterial blood pressure

Comparing mean arterial blood pressure between the 2 groups by millimeter of mercury (mmhg) at 0,5,10 and 15 minutes post-block.

Time frame: at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block

To monitor heart rate

Comparing the heart rate ( by beats per minute) in the 2 groups at 0,5,10 and 15 minutes post-block.

Time frame: At baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block