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
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 24
- 试验地点
- 1
- 主要终点
- To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18-70 years.
- •ASA I-II.
- •Confirmed primary unilateral hip fracture.
- •Scheduled for surgery under spinal anesthesia.
- •Patients able to provide informed consent.
排除标准
- •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.
研究组 & 干预措施
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
干预措施: 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
干预措施: 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
干预措施: 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%)
干预措施: 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%)
干预措施: 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%)
干预措施: 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%)
干预措施: LCFN block (Procedure)
结局指标
主要结局
To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups
时间窗: 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
次要结局
- 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)
研究者
Maha Salah
principal investigator
Ain Shams University