Which Analgesia is Better for Proximal Femoral Fractures?

Mansoura University

Status: Unknown

Conditions: Proximal Femur Fracture

Treatments: Procedure: Fascia iliaca block; Procedure: combined LFCN block with PENG block

Study type: Interventional

Funder types: Other

Identifiers

NCT04309539

MFM-IRB, MD.20.02.280

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 100 estimated patients

Sex: All

Ages: 50 to 90 years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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100 participants in 2 patient groups

Fascia iliaca block

Active Comparator group

Description:

Patients will receive Fascia iliaca block

Treatment:

Procedure: Fascia iliaca block

combined LFCN block with PENG block

Active Comparator group

Description:

Patients will receive a combined lateral femoral cutaneous nerve block with pericapsular nerve group block

Treatment:

Procedure: combined LFCN block with PENG block