Comparison of analgesic efficacy among pericapsular nerve group block(PENG) fascia iliaca compartment block (FICB) and femoral nerve block (FNB) for positioning during subarachnoid block in proximal femur fractures - a hospital based a randomized controlled trial

Hip and neck of femur fractures are the most commonly occurring serious injuries in older people where the need for emergency anaesthesia and surgery increases and account for the most common cause of death following accident. Upto 50-70% of patients record severe to very severe pain on pain scoring in the first 24 hours following hip fractures.

Severe pain encountered during positioning for spinal anaesthesia can worsen the patient experience psychologically and physically . Regional blocks facilitate patient positioning for spinal anaesthesia like the Fascia Iliaca Compartment Block, Pericapsular Nerve Group Block for efficacious pain control.

Primary Objective : Assessment of pain after PENG Block or FICB or FNBat the time of positioning for spinal anaesthesia in proximal femur fractures.

**Inclusion Criteria :**Age 18 years and above.

Patients undergoing fixation of femur fractures surgeries under spinal anaesthesia.

Either sex.

Patients willing to give consent.

Exclusion Criteria : Hypersensitivity to local anaesthesia.

Pre-existing respiratory, cardiovascular, neurological, renal disorders.

Alcohol or drug abuse.

Patients who do not fulfil inclusion criteria.

Study Protocol :

After obtaining the approval of ethical committee and written informed consent, a total of 90 patients (30 in each group) undergoing surgery under regional anaesthesia will be included in the study. Patients will be randomised  based on computer generated randomization table into one of the three groups.

After confirming NBM status prior to the block pain score assessed by visual analogue scale and vitals monitored, block is given 30 minutes before the surgery.

**Group P :**Will be receiving PENG Blockwith **15ml of 0.75% Ropivacaine.**A curvilinear low frequency ultrasound probe is placed over the line parallel to the inguinal ligament , rotated 45 degree to identify the anterior inferior iliac spine, the iliopubic eminence and psoas tendon. A 22 gauge needle is inserted in an in-plane approach to place the tip between pubic ramus posterior and psoas tendon anterior using hydrodissection technique.  Following negative aspiration a total volume of 15ml of ropivacaine (0.75%) injected.

**Group F :**Will be receiving FICB with **15ml of 0.75% Ropivacaine.**A linear ultrasound probe placed over the inguinal ligament in saggital plane, inferior medially to anterior superior iliac spine. Identify the bow tie sign formed by sartorius and the internal oblique muscle by sliding medially and rotating probe.  A 22 gauge needle introduced 1cm cephalad to the inguinal ligament to place the needle tip in the space between the internal oblique and iliacus muscles using hydrodissection technique. A total volume of 15ml of ropivacaine (0.75%) injected after negative aspiration.

Group FN : Will be receiving FNB with 15ml of 0.75% Ropivacaine. A linear ultrasound probe placed over femoral crease moved in lateral- medial direction to identify the artery. A 22 gauge needle introduced in an in-plane technique to nerve block the femoral nerve at the femoral crease. A total volume of 15ml of ropivacaine (0.75%) injected after negative aspiration.

Pain scores will be assessed after 30 minutes of giving the block to the patient using visual analogue scale before spinal anaesthesia.