Ultrasound-Guided PENG Block vs Femoral Nerve Block for Analgesia Before Spinal Anesthesia in Hip Fracture Surgery

Ain Shams University

Status: Not yet enrolling

Conditions: Spinal Anesthesia; Hip Fracture; Proximal Femur Fracture; Pain Management

Treatments: Procedure: Femoral Nerve Block (FNB); Procedure: Pericapsular Nerve Group (PENG) Block

Study type: Interventional

Funder types: Other

Identifiers

NCT06989047

FMASU MS49/2024

Details and patient eligibility

About

This study will compare two types of ultrasound-guided nerve blocks-Pericapsular Nerve Group (PENG) block and Femoral Nerve Block (FNB)-to evaluate their effectiveness in reducing pain before spinal anesthesia in patients who will undergo surgery for proximal femur fractures. Proximal femur fractures will continue to be common, especially in older adults, and often will cause severe pain that will make it difficult to position patients for spinal anesthesia. Both nerve blocks will aim to reduce pain, improve comfort during spinal anesthesia, and decrease the need for postoperative pain medication.

A total of 60 adult patients who will undergo proximal femur fracture fixation under spinal anesthesia will be enrolled and randomly assigned to receive either a Pericapsular Nerve Group (PENG) block or a femoral nerve block before the procedure. The study will monitor patients' pain scores using the Visual Analog Scale (VAS) at multiple time points, including during positioning and throughout the first 24 hours after surgery. It also will evaluate how long it will take before the patients require rescue pain medication, and how much total pain medication will be needed.

Enrollment: 60 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥ 18 years
• Scheduled for proximal femur fracture fixation under spinal anesthesia
• Classified as American Society of Anesthesiologists (ASA) physical status I, II, or III
• Ability to understand and use the Visual Analog Scale (VAS)
• Provided written informed consent

Exclusion criteria

• Coagulopathy
• Local infection at the injection site
• Known allergy to local anesthetics or magnesium sulfate
• Severe cardiopulmonary disease [American Society of Anesthesiologists (ASA) ≥ IV]
• Preexisting diabetic or other neuropathies
• Chronic opioid use
• Contraindication to spinal anesthesia
• Cognitive impairment or inability to comprehend Visual Analog Scale (VAS)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 2 patient groups

PENG Block Group

Experimental group

Description:

Assigned Interventions: Procedure/Surgery: Pericapsular Nerve Group (PENG) Block An ultrasound-guided nerve block targeting articular branches of the femoral, obturator, and accessory obturator nerves. Performed under aseptic technique using a curved low-frequency ultrasound probe to visualize the iliopsoas plane and pubic ramus. Drug: Bupivacaine (0.25%, 30 ml) Local anesthetic used to provide analgesia in nerve block. Drug: Magnesium sulfate (10%, 5 ml = 500 mg) Adjunct used to enhance analgesic efficacy of the block.

Treatment:

Procedure: Pericapsular Nerve Group (PENG) Block

Femoral Nerve Block Group

Active Comparator group

Description:

Assigned Interventions: Procedure/Surgery: Femoral Nerve Block (FNB) An ultrasound-guided nerve block targeting the femoral nerve, performed with an in-plane ultrasound approach under sterile conditions, identifying the nerve lateral to the femoral artery. Drug: Bupivacaine (0.25%, 30 ml) Local anesthetic used for nerve block. Drug: Magnesium sulfate (10%, 5 ml = 500 mg) Adjunct analgesic agent.

Treatment:

Procedure: Femoral Nerve Block (FNB)