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临床试验/NCT04285333
NCT04285333已完成不适用

Analgesic Techniques Before Spinal Anesthesia for Hip Fracture Repair: Ultrasound Percapsular Nerve Group Block VS Fascia Iliaca Block

University Tunis El Manar2 个研究点 分布在 1 个国家目标入组 88 人开始时间: 2020年3月17日最近更新:
适应症

试验速览

阶段
不适用
状态
已完成
发起方
入组人数
88
试验地点
2
主要终点
positioning pain

研究概览

简要总结

Spinal anesthesia (SA) is a widely accepted anesthetic technique for hip fracture repair among elderly. Positioning for SA can be extremely painful. Effective management of pain is important for these patients comfort.

Fascia Iliaca block (FIB) and Femoral nerve blocks are commonly used for analgesia in hip fracture patients. However, they often provide a modest reduction in pain.

The Percapsular Nerve Group block (PENG Block) has the advantage that it covers the accessory obturator nerve.

Aim of the study: compare FIB with PENG prior to positioning hip fracture patients for standardized SA.

In a prospective randomized double blind we included 80 patients aged more than 65 years old, for whom pain was felt when raising the affected limb to 15 degrees. Patients were assigned to receive either ultrasound guided Fascia Iliaca block or Percapsular Nerve Group block using 20 mL Lidocaine 1.5% in both groups. We compared pain on positioning for spinal anesthesia using Verbal Rating Scale (VRS 0 = no pain , VRS 1 = mild pain, t 2= severe pain) for both groups. We also recorded different times to perfom block.

详细描述

The purpose of the study was to compare analgesis effect of Percapsula nerve group block to fascia iliaca block prior to positioning hip fracture patients for standardized SA. We included 80 patients reporting pain with Verbal Rating Scale at 2 when raising the affected limb to 15 degrees. All patients admitted to induction room, were given standard monitoring and we randomized to receive either: ultrasound fascia iliaca block using linear high frequency ultrasound probe (10-15MHz) placed in a transverse direction over the anterior thigh below the inguinal ligament. A 50 mm needle was advanced until the tips placed underneath the fascia iliaca and 20 mL 1.5% Lidocaine was injected or ultrasound Percapsula nerve group block A curvilinear using low-frequency ultrasound probe (2-5MHz) that was initially placed in a transverse plane over the anterior inferior iliac spine and then aligned with the pubic ramus by rotating the probe counter clockwise approximately 45 degrees. In this view, the iliopubic eminence , the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle were observed and than a 100 mm needle was advanced to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly and 20 mL 1.5% Lidocaine.We compared pain on positioning for spinal anesthesia and also different time to realise both blocks.

研究设计

研究类型
Interventional
分配方式
Randomized
干预模型
Parallel
主要目的
Treatment
盲法
Double (Participant, Care Provider)

盲法说明

all blocks were performed in a special area outside operating room by docters only implicated in performance assessement of block and not in patient care. Patients where after moved to operating room, care provider wil assess pain before spinal anesthesia

入排标准

年龄范围
65 Years 至 —(Older Adult)
性别
All
接受健康志愿者

入选标准

  • - Patients aged ≥ 65 years old and undergoing hip fracture surgical repair under continuous spinal anesthesia (CSA).
  • Patients for whom pain was felt when raising the affected limb to 15 degrees (VERBAL PAIN SCALE =2)

排除标准

  • - ASA physical status ≥
  • Impaired cognition or Dementia.
  • Multiple fractures.
  • Contraindication to regional anesthesia.
  • Patient's disapproval.

结局指标

主要结局

positioning pain

时间窗: up to 30 minutes

Verbal Rating Scale (VRS) \[0=no pain ; 4=worst pain\]

次要结局

  • pain 10 after block(up to 10 minutes)
  • Positioning Rating(up to 40 minutes)
  • Performance time(up to 10 minutes)
  • Number of punctures(up to 10 minutes)
  • Imaging time(up to 10 minutes)
  • Puncture time(up to 10 minutes)
  • pain 5 after block(up to 5 minutes)
  • pain 15 after block(up to 15 minutes)
  • pain 20 after block(up to 20 minutes)

研究者

发起方
University Tunis El Manar
申办方类型
Other
责任方
Principal Investigator
主要研究者

Olfa kaabachi, MD

Professor

University Tunis El Manar

研究点 (2)

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