Peri-capsular Nerve Group Block Versus Fascia Iliaca Block for Hip Arthroplasty

Cairo University (CU)

Status: Unknown

Conditions: Post Operative Pain Management

Treatments: Procedure: Fascia Iliaca BLock; Procedure: Pericapsular nerve group block

Study type: Interventional

Funder types: Other

Identifiers

NCT03783247

Swelam PENG block

Details and patient eligibility

About

In this study, the investigator will examine the efficacy of Pericapsular nerve group (PENG) block in hip surgeries as a post-operative pain management technique in comparison with fascia Iliaca block in hip surgeries

Full description

Hip fracture is a common orthopedic emergency in the elderly, and it is associated with significant morbidity and mortality.1 Surgical reduction and fixation are the definitive treatment in most patients.2 Effective perioperative analgesia that minimizes the need for opioids and related adverse effects (such as delirium) is essential in this patient population.

Regional analgesic techniques, including femoral nerve (FN) block, fascia iliaca block (FIB), and 3-in-1 FN block, are popular analgesic strategies, due mainly to their opioid-sparing effects and reduction in opioid-related adverse effects. The effect size of analgesia from these blocks is only moderate, and literature suggests that the obturator nerve (ON) is not covered.

The anterior hip capsule is innervated by the ON, accessory obturator nerve (AON), and FN as reported by previous anatomic studies. The anterior capsule is the most richly innervated section of the joint, suggesting these nerves should be the main targets for hip analgesia. A recent anatomical study by Short et al15 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. This study also identified the relevant landmarks for those articular branches. The high articular branches from FN and AON are consistently found between the anterior inferior iliac spines (AIIS) and the iliopubic eminence (IPE), whereas the ON , close to the inferomedial acetabulum. Using this information, the investigator developed an ultrasound-guided technique for blockade of these articular branches to the hip, the PENG (PEricapsular Nerve Group) block. In this study, the investigator will examine the efficacy of PENG block in hip surgeries as a post-operative pain management technique in comparison with fascia Iliaca block in hip surgeries

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients scheduled for hip replacement surgeries e.g. hip hemiarthroplasty, total hip arthroplasty under subarachnoid block (SAB)

Exclusion criteria

• Coagulopathy
• infection at the injection site
• allergy to local anesthetics
• severe cardiopulmonary disease (≥ASA IV)
• diabetic or other neuropathies
• patients receiving opioids for chronic analgesic therapy
• contraindication to spinal anesthesia
• inability to comprehend visual analog scale (VAS).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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50 participants in 2 patient groups

FIB

Experimental group

Description:

hip fracture with fascia Iliaca block

Treatment:

Procedure: Fascia Iliaca BLock

PENG

Experimental group

Description:

Hip fracture with Pericapsular nerve group block

Treatment:

Procedure: Pericapsular nerve group block