Pericapsular Nerve Group Block Versus Fascia Iliaca Block for Pediatric Hip Surgery

Not Applicable

Interventions: Procedure: Caudal Block group
Procedure: Fascia iliaca group
Procedure: Pericapsular nerve group block

Brief Summary: This compares the postoperative analgesic effect of ultrasound-guided pericapsular nerve group block (PENG) with ultrasound-guided fascia iliaca compartment block in pediatric patients undergoing hip surgery.

Detailed Description: Surgeries involving hip joints in pediatric patients are associated with severe intraoperative and postoperative pain despite the use of systemic opioids.

Caudal block is the most commonly used method of regional anesthesia in children to control intraoperative and postoperative pain in surgeries involving lower limbs. However, there have been many side effects of caudal block such as hypotension, urine retention, excessive motor block, technical failure, nausea, and vomiting which may limit its use.

There are several techniques of ultrasound-guided regional anesthesia that are used to control acute pain in hip surgery with fewer side effects such as a lumbar plexus block, femoral nerve block, or a fascia iliaca compartment block.

The fascia iliaca compartment block (FICB) was described in 1989. It remains a popular regional anesthetic technique for surgical procedures involving the hip joint and femur. Local anesthetic (LA) is injected proximally beneath the fascia iliaca to block the femoral nerve (FN), obturator nerve (ON), and lateral cutaneous nerve of the thigh (LCNT) simultaneously.

The pericapsular nerve group (PENG) block was introduced to block the articular branches of the femoral, obturator, and accessory obturator nerves which provide sensory innervation to the hip. This regional anesthetic technique was described in 2018 for acute analgesia related to hip fractures.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Children with the severe systemic disease with American Society of Anesthesiologists physical activity class III or IV.
Children with previous neurological or spinal disorders.
Coagulation disorder.
Infection at the block injection site.
History of allergy to local anesthetics.

Arm && Interventions

Group	Intervention	Description
Caudal Block group	Caudal Block group	25 patients will receive ultrasound-guided caudal block with bupivacaine 0.25% (0.5 mL/kg) after induction of anesthesia.
Fascia iliaca group	Fascia iliaca group	25 patients will receive ipsilateral ultrasound-guided Fascia iliaca compartment block with bupivacaine 0.25% (0.5 m. L/kg) after induction of anesthesia.
Pericapsular nerve group block	Pericapsular nerve group block	25 patients will receive ipsilateral ultrasound-guided Pericapsular nerve group block with bupivacaine 0.25% (0.5 mL/kg) after induction of anesthesia.

Primary Outcome Measures

Name	Time	Method
Total Opioids consumption	24 hours postoperatively	Total Opioids consumption in first 24 hour postoperatively will be recorded

Secondary Outcome Measures

Name	Time	Method
Adverse effects	24 hours Postoperatively	Adverse effects: hypotension, Bradycardia, hematoma, and local anesthetic toxicity will be observed and treated accordingly.
Heart rate	Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours	Perioperative heart rate will be observed
Postoperative pain	At post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours.	Postoperative pain which will be assessed by face, legs, activity, and cry consolability scale \[FLACC\]
Time to first rescue analgesia	24 hours Postoperatively	Time of administration of first rescue analgesia will be recorded.
Mean arterial blood pressure	Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours.	Perioperative mean arterial blood pressure will be observed