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

Not Applicable

• Conditions: Post Operative Pain Management
• Interventions: Procedure: Pericapsular nerve group block; Procedure: Fascia Iliaca BLock

• Registration Number: NCT03783247
• Lead Sponsor: Cairo University

Brief Summary

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

Detailed 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

Study Timeline

• Status Verified: 2018-12
• Study First Submitted: 2018-12-18
• Study First Submitted QC: 2018-12-19
• Last Update Submitted: 2018-12-19
• Study First Posted: 2018-12-21
• Last Update Posted: 2018-12-21
• Study Start: 2019-02-15
• Primary Completion: 2019-05-31
• Study Completion: 2019-06-20

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 50

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).

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PENG	Pericapsular nerve group block	Hip fracture with Pericapsular nerve group block
FIB	Fascia Iliaca BLock	hip fracture with fascia Iliaca block

Primary Outcome Measures

Name	Time	Method
morphine consumption	24 hours	total morphine consumption over 24 hours

Secondary Outcome Measures

Name	Time	Method
muscle power	24 HOURS	Assessment of quadriceps femoris muscle strength: For motor block assessment, the patient will be in supine position and the patient's knee will be fully flexed, and the patient will be asked to extend it. The motor block is classified as follows: grade 0; normal muscle power, grade I; motor weakness, grade II; complete motor paralysis
pain scale Visual analogue Scale	24hours	Using a ruler, the score is determined by mea-suring the distance (mm) on the 10-cm line between the "no pain" anchor and the patient's mark, providing a range of scores from 0-100. A higher score indicates greater pain intensity.

Trial Locations

Locations (1)

Cairo University; 🇪🇬 Cairo, Giza, Egypt