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

Not Applicable

Not yet recruiting

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

• Registration Number: NCT06989047
• Lead Sponsor: Ain Shams University

Brief Summary

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.

Detailed Description

Not available

Study Timeline

• Status Verified: 2025-05
• Study First Submitted: 2025-05-07
• Study First Submitted QC: 2025-05-16
• Last Update Submitted: 2025-05-16
• Study First Posted: 2025-05-25
• Last Update Posted: 2025-05-25
• Study Start: 2025-05-30
• Primary Completion: 2026-05-30
• Study Completion: 2026-05-30

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 60

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)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Pain Score During Positioning for Spinal Anesthesia Using Visual Analog Scale (VAS)	Immediately before spinal anesthesia (within 15 minutes post-block)	The Visual Analog Scale (VAS) will be used to assess pain intensity during positioning for spinal anesthesia. The VAS is a 10 cm line where 0 indicates no pain and 10 indicates the worst imaginable pain. The score will be recorded immediately before spinal anesthesia after performing either the PENG block or femoral nerve block.
Time to First Rescue Analgesia	Within 24 hours postoperatively	The time (in hours) from the end of the nerve block to the first request for additional analgesia (nalbuphine 0.2 mg/kg IV) will be recorded for each patient.

Secondary Outcome Measures

Name	Time	Method
Total Nalbuphine Consumption	24 hours postoperatively	The cumulative dose (in mg) of intravenous nalbuphine administered for pain control will be calculated for each participant over the first 24 hours following surgery.
Mean Arterial Pressure (MAP) Changes	From baseline up to 24 hours postoperatively	Mean arterial pressure will be recorded at baseline (pre-block), then at 2, 5, 10, 15 minutes post-block, and subsequently at 2, 6, 12, 18, and 24 hours after surgery to evaluate hemodynamic stability following either pericapsular nerve block (PENG) block or femoral nerve block.
Patient Satisfaction Score	At 24 hours postoperatively	Patient satisfaction with pain control will be evaluated using a 5-point Likert scale (1 = very dissatisfied, 5 = very satisfied) at the end of the 24-hour postoperative period.