Hip Hemiarthroplasty, Lateral Femoral Cutaneous Nerve Block, Pericapsular Nerve Group Block, Supra-inguinal Fascia Iliaca Block
Conditions
Brief summary
The aim of this study is to investigate the efficiency of preoperative and post-operative analgesia by pericapsular nerve group block (PENG) block with supra-inguinal fascia iliaca block (SIFIC) block compared with PENG block with lateral femoral cutaneous nerve block (LFCN) block in ease of giving a sitting position for spinal anesthesia and reducing narcotic consumption during the first 24 hour post-operatively and functional recovary by using the Visual analogue scale (VAS) of pain.
Detailed description
The established practice to decrease pain using opioids in hip fracture surgery may result in compromised outcomes in the frail and elderly population with nausea-vomiting, constipation, delirium and respiratory depression. This popularized the regional analgesic techniques in the surgical treatment of hip fractures. Femoral nerve (FN) and supra-inguinal fascia iliaca block (SIFIC) block are documented to provide good peri-operative analgesia with reduced need for opioids. The latest pericapsular nerve group block (PENG) block, is an interfacial plane block targeting the articular branches of the femoral, obturator (ON) and accessory obturator nerves (AON) at the hip. An ability to perform in supine positioning, which is especially important in patients with acute hip fractures or chronic pain is an indigenous advantage of PENG block. Due to the blockade of only sensory articular branches, substantial motor weakness is unexpected. But exclusive use of PENG block for analgesia in hip fracture patients is not sufficient as it doesn't involve the cutaneous pain-generating area supplied by the lateral femoral cutaneous nerve block (LFCN).
Interventions
OTHERPericapsular nerve group block (PENG) with supra-inguinal fascia iliaca block (SIFIC)
Patients will receive pericapsular nerve group (PENG) block with supra-inguinal fascia iliaca (SIFIC) block.
OTHERPericapsular nerve group block (PENG) with lateral femoral cutaneous nerve block (LFCN)
Patients will receive pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve (LFCN) block.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age 40-80 years. * Sex: Both sexes. * American Society of Anaesthesiologists (ASA) Physical Status Class I, II, and III. * Scheduled for hip hemiarthroplasty under general anesthesia.
Exclusion criteria
* Declining to give a written informed consent. * History of allergy to the medications used in the study. * Contraindications to regional anesthesia (including patient refusal, coagulopathy and local infection). * Psychiatric disorders or narcotic abusers. * Significant cognitive dysfunction. * American Society of Anesthesiologists (ASA) Physical Status Class IV. * Renal insufficiency (to avoid local anesthetic or nalbuphine metabolites adverse effect) * Opioid abuser patients * Pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Degree of pain will be assessed by visual analogue score (VAS). VAS ranging from 0 to 10, where 0 is no pain and 10 is maximum pain. It will be assessed preoperatively first after the block application then postoperatively, at post anesthesia care unit (PACU) and then 2, 6 ,12 ,18 ,24 hours postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The ease of giving a sitting position for spinal anesthesia (EOSP) | Intraoperatively | The ease of giving a sitting position for spinal anesthesia (EOSP) will be assessed by the EOSP score .EOSP was assessed on the scale of 0-3 (0 = unable to position, 1 = patient had abnormal posturing due to pain and required support for positioning, 2 = mild discomfort but does not require support for positioning, 3 = optimal condition where the patient was able to position himself |
| The total dose of nalbuphine consumption | 24 hours postoperatively | When visual analogue score (VAS) \>/=4, patients will receive injection nalbuphine 10 mg/70 kg (with maximum dose 160 mg over 24 hours) intravenously. |
| The number of patients who needed rescue analgesia | 24 hours postoperatively | Number of patients who needed rescue analgesia will be recorded |
| Ablility to walk with support within 24 hours | 24 hours postoperatively | The ability of patients to walk with support will be recorded |
Countries
Egypt
Outcome results
None listed