Femoral Neck Fractures, Intertrochanteric Fractures
Conditions
Keywords
PENG, FICB, Fascia Iliaca Compartment Block, Pericapsular Nerve Group Block, Hip fracture
Brief summary
Regional anesthesia for hip fractures has been shown to decrease rates of delirium in elderly patients with hip fractures as well as improve pain compared to systemic opioids. The Pericapsular Nerve Group (PENG) block has recently received attention as an alternative approach to femoral nerve block and Fascia Iliaca Compartment Block (FICB). The investigators seek to evaluate if there is a difference between the PENG and FICB in terms of efficacy of pain control in ED patients presenting with hip fracture. We hypothesize that the PENG block may be superior based on previous research.
Detailed description
Fractures of the proximal femur are a common presentation to the emergency department and are an acutely painful condition. This condition predominantly affects elderly patients who are at risk for delirium and more susceptible to the adverse effects of systemic opioids. Regional anesthesia is an recommended component of pain control for elderly patients with hip fracture. The investigators seek to compare the efficacy of pain control of the Pericapsular Nerve Group (PENG) block with the Fascia Iliaca Compartment Block (FICB). Previous studies have suggested that the PENG block may be superior to the FICB for pain control and results in less thigh motor weakness. The investigators will compare pain control (by difference in mean VAS score at set time points), systemic opioid use (in mean morphine equivalents prior to surgery), and motor function in patients with hip fractures who receive either block in the ED.
Interventions
PROCEDUREPENG
patients will receive an ultrasound-guided Pericapsular Nerve Group Block with 20mL of 0.25% bupivacaine (not to exceed 2mg/kg)
PROCEDUREFICB
Patients will receive an ultrasound-guided Fascia Iliaca Compartment Block with 20 mL of 0.25% bupivacaine (not to exceed 2 mg/kg) diluted to total volume of 40 mL of injectate
Sponsors
University of Virginia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Patients will be randomized to receive either a PENG or FICB. Baseline characteristics will be collected and NRS pain scores collected preblock and at specified time points post block.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Proximal femur fracture
Exclusion criteria
* refusal to consent * hemodynamic instability * allergy to local anesthetics * severe injury with instability * severe medical conditions with instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain score | 6 hours | Median pain score on 0-10 Numeric Rating Scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioid use | From block administration until time of surgery or 24 hours if surgery performed >24 hours | Mean opioid consumption in morphine equivalents |
Countries
United States
Outcome results
None listed