Comparative Study Between Pericapsular Nerve Group Block (PENG) And Pericapsular Nerve Group (PENG) Block Combined With Lateral Femoral Cutaneous Nerve (LFCN) Block for Positioning Analgesia Prior to Spinal Anesthesia in Hip Fracture Patients
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Ain Shams University
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups
Study Overview
Brief Summary
To evaluate and compare the effectiveness of the Pericapsular Nerve Group (PENG) block alone versus the PENG block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block in providing adequate analgesia for patient positioning during spinal anesthesia in individuals undergoing surgery for hip fracture.
Detailed Description
Hip fractures are common among adult patients and often necessitate urgent surgical intervention. Positioning these patients for spinal anesthesia in sitting position is often difficult due to intense pain from the fracture. PENG block is a novel regional technique that targets the articular branches of the femoral nerve, obturator nerve, and accessory obturator nerve, providing excellent anterior hip analgesia sparing the motor function. It is performed under ultrasound guidance and has shown promising results in perioperative pain management. By combining LFCN block with the PENG block, more complete sensory blockade may be achieved. The effectiveness of this combination has not yet been adequately studied, particularly regarding positioning for spinal anesthesia. Therefore, this trial aims to compare the analgesic efficacy of PENG block alone versus PENG +LFCN block in this specific context.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 18 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age 18-70 years.
- •ASA I-II.
- •Confirmed primary unilateral hip fracture.
- •Scheduled for surgery under spinal anesthesia.
- •Patients able to provide informed consent.
Exclusion Criteria
- •Allergy to local anesthetics.
- •Coagulopathy or on anticoagulant therapy.
- •Infection at injection site.
- •Pre-existing neurological deficits in the lower limbs.
- •Multiple trauma or polytrauma (If other injuries might interfere with positioning or pain scoring).
- •Previous surgery on the ipsilateral hip affecting anatomy or nerve distribution.
Arms & Interventions
group A (PENG BLOCK)
The patient is positioned supine and hip extended. 3 mL of 2% lidocaine is injected at the insertion site using a hyperechoic needle guided by ultrasound using a low-frequency probe. At the anterior superior iliac spine level, the probe is placed parallel to the inguinal fold, and scanning is performed with a gradual movement of the probe head. When the lower anterior inferior iliac spine is observed, the probe is rotated slightly median until a continuous hyperechoic shadow of the upper pubic ramus is visible. This maneuver help to identify the psoas muscle with a prominent tendon above the pubic ramus. The target is located in the plane between these 2 structures. The pubic ramus should be aligned in the center of the image to target the pubic ramus just inside the anterior inferior iliac spine. A 100-mm nerve block needle can be introduced, and 20 ml of 0.25% of Bupivacaine (10 ml of Bupivacaine 0.5% is added to 10ml of Lidocaine 2%) is administered
Intervention: PENG Block (Procedure)
group A (PENG BLOCK)
The patient is positioned supine and hip extended. 3 mL of 2% lidocaine is injected at the insertion site using a hyperechoic needle guided by ultrasound using a low-frequency probe. At the anterior superior iliac spine level, the probe is placed parallel to the inguinal fold, and scanning is performed with a gradual movement of the probe head. When the lower anterior inferior iliac spine is observed, the probe is rotated slightly median until a continuous hyperechoic shadow of the upper pubic ramus is visible. This maneuver help to identify the psoas muscle with a prominent tendon above the pubic ramus. The target is located in the plane between these 2 structures. The pubic ramus should be aligned in the center of the image to target the pubic ramus just inside the anterior inferior iliac spine. A 100-mm nerve block needle can be introduced, and 20 ml of 0.25% of Bupivacaine (10 ml of Bupivacaine 0.5% is added to 10ml of Lidocaine 2%) is administered
Intervention: bupivacaine 0.25%. (Drug)
group A (PENG BLOCK)
The patient is positioned supine and hip extended. 3 mL of 2% lidocaine is injected at the insertion site using a hyperechoic needle guided by ultrasound using a low-frequency probe. At the anterior superior iliac spine level, the probe is placed parallel to the inguinal fold, and scanning is performed with a gradual movement of the probe head. When the lower anterior inferior iliac spine is observed, the probe is rotated slightly median until a continuous hyperechoic shadow of the upper pubic ramus is visible. This maneuver help to identify the psoas muscle with a prominent tendon above the pubic ramus. The target is located in the plane between these 2 structures. The pubic ramus should be aligned in the center of the image to target the pubic ramus just inside the anterior inferior iliac spine. A 100-mm nerve block needle can be introduced, and 20 ml of 0.25% of Bupivacaine (10 ml of Bupivacaine 0.5% is added to 10ml of Lidocaine 2%) is administered
Intervention: Xylocaine 2 % (Drug)
Group B (PENG block and LCFN block)
in addition to PENG block ( as described before), LFCN block is performed by using a linear array ultrasound probe a cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then the probe is moved in a medial and caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection of 8ml of 0.25% of Bupivacaine (4 ml of Bupivacaine 0.5% is added to 4 ml of Lidocaine 2%)
Intervention: bupivacaine 0.25%. (Drug)
Group B (PENG block and LCFN block)
in addition to PENG block ( as described before), LFCN block is performed by using a linear array ultrasound probe a cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then the probe is moved in a medial and caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection of 8ml of 0.25% of Bupivacaine (4 ml of Bupivacaine 0.5% is added to 4 ml of Lidocaine 2%)
Intervention: Xylocaine 2 % (Drug)
Group B (PENG block and LCFN block)
in addition to PENG block ( as described before), LFCN block is performed by using a linear array ultrasound probe a cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then the probe is moved in a medial and caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection of 8ml of 0.25% of Bupivacaine (4 ml of Bupivacaine 0.5% is added to 4 ml of Lidocaine 2%)
Intervention: PENG Block (Procedure)
Group B (PENG block and LCFN block)
in addition to PENG block ( as described before), LFCN block is performed by using a linear array ultrasound probe a cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then the probe is moved in a medial and caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection of 8ml of 0.25% of Bupivacaine (4 ml of Bupivacaine 0.5% is added to 4 ml of Lidocaine 2%)
Intervention: LCFN block (Procedure)
Outcomes
Primary Outcomes
To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups
Time Frame: from initiation of patient positioning until optimal positioning is achieved during the spinal anesthesia procedure
time taken in seconds for positioning for spinal anesthesia 15 minutes post- block
Secondary Outcomes
- To assess Numerical Rating Pain Score in both groups at 0,5,10 and 15 minutes post block(at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block)
- To assess patient satisfaction and comfort during positioning using Likert scale(during patient positioning 15 minutes after completion of the block)
- To monitor mean arterial blood pressure(at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block)
- To monitor heart rate(At baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block)
Investigators
Maha Salah
principal investigator
Ain Shams University