A Randomized comparative study of ultrasound guided(USG) pericapsular nerve group block (PENG) using 0.25% Bupivaicaine with or without magnesium sulphate for positional comfort during neuraxial block in hip fracture patients

A Prospective Double Blinded Randomized Comparative study of Ultrasound guided (USG) Pericapsular Nerve Group Block (PENG) using ) 0.25% Bupivaicaine with or without magnesium sulphate for positional comfort during neuraxial block in Hip fracture patients.

PENG block is a newer technique using USG guidance to block femoral nerve and obturator nerve and sparing quadriceps femoris muscle. The aim of study is to compare the efficacy of PENG block with or without magnesium sulphate for  positional comfort during neuraxial block in patients of age of 18- 70 yrs scheduled for emergency / elective hip surgeries .

Thorough preoperative evaluation and neccessary investigations and informed consent of patients / relatives is taken. In preoperative room, all patients are randomly allotted to one of 2 groups, group M and group N by computer generated randomization via Research Randomizer Software ( www.randomizer.org).The allocation concealment is ensured using sequentially numbered opaque sealed envelope (SNOSE) technique.The study solutions prepared by one anaesthesiologist who will not be involved in further study.

In preoperative area , all patients will be secured with 18 G IV cannula , started ringer lactate (RL) IV fluids  and monitored for NIBP, ECG and SPO2 .  Pain during rest and pain on 30 degree passive limb elevation will be assessed by NRS ( Numerical Rating Scale).Routine preparation of anaesthesia machine and drugs will be done.

Takaing all precautions ,under aseptic conditions , a low frequency curvilinear USG probe ( 2-5 MHz) will be placed over line joining anterior superior iliac spine(ASIS)  and pubic tubercle , keeping lateral margin at ASIS and adjusted probe to get sono -anatomical view of PENG block. The needle entry point on skin is selected in such a manner that perpendicular needle entry will guide needle near target point (ilio-pubic eminence), 21 G peripheral nerve stimulator (PNS) needle is inserted to reach bony rim near ilio-pubic eminence avoiding injury to femoral nerve. In Group M 18 ml 0.25% Bupivaicaine with 2 ml 10% magnesium sulphate and in group N 18 ml of 0.25 % Bupivaicaine with 2ml of normal saline slowly injected with repeated aspirations to avoid intravascular injections.

Outcomes to be assessed after PENG BLOCK in both groups:

• After 30 minutes pain will be reassesed at rest and 30 degree passive limb elevation by using NRS pain intensity score .
• The comfort during sitting for spinal anaesthesia will also be assessed by EOSP(EASE OF SPINAL ANAESTHESIA) score.
• Time taken for first rescue analgesia after PENG BLOCK.
• Total rescue analgesia required in the first 24 hours.

The following data will be collected : Demographic parameters of the patients such as age, height , weight, body mass index , vital parameters like heart rate , respiratory rate, ECG, oxygen saturation and MAP mean arterial pressure before and after delivering analgesia . Any adverse events such as bleeding , needle kinking will also be noted. Fluid management is done as per standard fluid resuscitation guidelines. all data ( related to variables of study ) assessed , will be entered in MS EXCEL sheet , cleaned and analysed. Related categorical and numerical variables will be subjected to suitable statistical tests. The numerical variables will be assessed for uniformity of distribution , before assessing for parametric and non parametric tests.