Lateral Cutaneous Nerve and PENG Blocks Versus Suprainguinal Fascia Iliaca Block in Post-op Analgesia of Hip Fractures
- Conditions
- Anesthesia, Conduction
- Interventions
- Drug: Saline solution + Ropivacaine
- Registration Number
- NCT05749367
- Lead Sponsor
- Federal University of Minas Gerais
- Brief Summary
Postoperative pain in hip fractures is challenging and requires adequate management. Peripheral nerve blocks are already known as superior than systemic analgesia in this scenario, but the best analgesic regional technique is still unknown. The investigators propose a study to compare the postoperative analgesia of hip fractures between pericapsular nerve group block plus lateral femoral cutaneous nerve block and suprainguinal fascia iliaca block
- Detailed Description
Postoperative pain in hip fractures is challenging and requires adequate management. In this scenario, peripheral nerve blocks present superior results to systemic analgesia, minimizing the use of opioids and their adverse effects. The lumbar plexus is responsible for the nociception of the hip joint through the femoral, obturator, and accessory obturator nerves, besides being responsible for the sensory innervation of the lateral aspect of the thigh through the lateral femoral cutaneous nerve. Due to this intricate network, several regional techniques have already been proposed. However, the best analgesic approach is still unknown. Ultrasound-guided suprainguinal fascia iliaca block (SIFIB), which addresses the femoral and lateral femoral cutaneous nerves, and ultrasound-guided pericapsular nerve group block (PENG), which addresses terminal branches of the femoral and accessory obturator nerves, are techniques currently used successfully in the context of analgesia for hip surgery. PENG block generates less motor impairment of the quadriceps, which can be significant in terms of mobility and rehabilitation. Both techniques show similar analgesic results in the still scarce literature, but SIFIB has shown slight advantage in some scenarios. However, the PENG block does not reach the lateral cutaneous nerve, which may lead to greater postoperative pain perception. In an attempt to fill this knowledge gap, the investigators propose a study to analyze whether the association between PENG block and lateral femoral cutaneous nerve block (LFCNB) promotes postoperative analgesia equal to SIFIB in a population of adults with hip fractures. This will be a prospective, controlled, randomized, double blind study. Patients with hip fractures (femoral neck, transtrochanteric and subtrochanteric) who will undergo surgical treatment (hip arthroplasty and osteosynthesis with intramedullary nails or screws) will be recruited and randomly allocated into two groups: control (C) and experimental (E). In group C, patients will undergo SIFIB with 30 ml of 0.5% ropivacaine, and to maintain blinding they will also undergo PENG and LFCNB with 20 ml and 10 ml of saline, respectively. In group E, patients will receive the PENG block associated with LFCNB, with 20ml + 10ml of 0.5% ropivacaine, respectively, and 30 ml of saline solution in the SIFIB. After performing the blocks, all patients will undergo spinal anesthesia, with intrathecal injection of 10mg of 0.5% isobaric bupivacaine. As a primary objective, the investigators will evaluate dynamic pain (passive elevation of the leg at 15°) using the Numeric Rating Scale (0-10), 6 hours, 12 hours and 24 hours after spinal anesthesia.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 66
- Patients with hip fractures who will undergo surgical treatment.
- Adults over 18 years.
- American Society of Anesthesiology physical status 1 to 3.
- Body mass index (BMI) < 35 Kg/m2.
- Local anesthetic allergy
- Coagulopathy
- American Society of Anesthesiology physical status ≥ 4,
- Dementia
- Peripheral polyneuropathy
- Pregnancy
- Chronic opioid use (> 3 months)
- BMI >35 Kg/m2
- Stroke with lower limb motor sequelae
- Patient refusal/withdrawal
- Those whose spinal anesthesia has been changed to general anesthesia.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Suprainguinal Fascia Iliaca Block Group Ropivacaine + saline solution Patients will undergo SIFIB with ropivacaine and PENG plus LFCNB with saline solution. PENG Block + Lateral Femoral Cutaneous Nerve Block Group Saline solution + Ropivacaine Patients will undergo SIFIB with saline solution and PENG plus LFCNB ropivacaine.
- Primary Outcome Measures
Name Time Method Dynamic Post-op Hip Pain 24 hours after spinal anesthesia To assess dynamic hip pain (passive leg elevation at 15°) in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from (no pain) to 10 (worst possible pain).
- Secondary Outcome Measures
Name Time Method Post-op Hip Pain at Rest 6 hours, 12 hours and 24 hours after spinal anesthesia. To evaluate hip pain at rest in postoperative period using the Numeric Rating Scale (0-10), on which patients rate their current pain intensity from ) (no pain) to 10 (worst possible pain)..
Quadriceps muscle strength measured by dynamometry in newton (N). 6 hours, 12 hours and 24 hours after spinal anesthesia. To test the quadriceps muscle strength by dynamometry (Med Force hand-held push dynamometer, tHHD, MED.DOR Ltd., Governador Valadares, Brazil) in newton.
Quadriceps muscle strength index 6 hours, 12 hours and 24 hours after spinal anesthesia. To calculate quadriceps muscle strength index by the ratio between the strengths (collected by dynamometry) of the non-operated and operated lower limbs.
Total intravenous morphine dose in milligram over 24 hours 24 hours To quantify the total rescue morphine dose (or morphine equivalent) in mg over 24h.
Time of the first morphine order in minutes 24 hours To record the time of the first morphine order in minutes after the spinal anesthesia
Incidence of opioid side effects 24 hours To record the incidence of opioid side effects - nausea/vomiting, pruritus, urinary retention and respiratory depression
Incidence of blockades complications 24 hours To record the incidence of blockades complications - vascular puncture, hematoma, local anesthetic toxicity and nerve injury.
Incidence of delirium 24 hours To evaluate altered cognition and conclude as positive or negative.
Trial Locations
- Locations (1)
Hospital Odilon Behrens
🇧🇷Belo Horizonte, Minas Gerais, Brazil