Pericapsular Nerve Group Bloc, Postoperative Cognitive Dysfunction, Total Hip Replacement
Conditions
Keywords
Total hip replacement, Pericapsular nerve group bloc, Postoperative cognitive dysfunction
Brief summary
The aim of this study was to examine the effect of pericapsular nerve group (PENG) block, which is frequently applied for postoperative analgesia in total hip replacement surgeries performed under spinal anesthesia, on postoperative cognitive function in patients aged 65 years and older. The main question of the study is as follows: Can the analgesic effect of preoperative PENG block without causing motor block in total hip replacement surgeries performed under spinal anesthesia in patients aged 65 years and older reduce the incidence of postoperative cognitive dysfunction (POCD)?
Detailed description
Patients aged 65 years and older, with (American Society of Anesthesiologists) ASA physical status I, II and III, and scheduled for total hip arthroplasty surgery under spinal anesthesia will be included in the study. Patient characteristics (age, gender, body mass index, etc.), Confusion Assessment Method (CAM), Yesavage Geriatric Depression Scale, Frail Frailty and Mini-Mental State Examination (MMSE) performed face-to-face will be recorded. Preoperatively, 24-72 hours before, patients' cognitive functions will be re-evaluated out of 26 points with telephone versions of the MMSE (T-MMSE). Intraoperatively, surgical duration, dermatomal block level due to spinal anesthesia, ephedrine or atropine requirement, pulse and blood pressure values will be recorded during the surgery. One group will receive a single dose ipsilateral pericapsular nerve group (PENG) block (20 ml 0.25% plain bupivacaine) under ultrasound guidance before surgery. The other group will receive a sham block. Cognitive function of the patients will be evaluated with T-MMSE on the 1st, 7th, 30th and 90th days postoperatively. Postoperative pain status of the patients will be recorded face-to-face at 0, 2, 8, 16, 24 and 48 hours, and via telephone on the 7th, 30th and 90th days with numerical rating scale (NRS).
Interventions
OTHERPericapsular nerve group block
Pericapsular nerve group block will be applied to patients in addition to standard treatment to prevent postoperative pain
OTHERNo Pericapsular nerve group block
Patients will be given standard treatment to prevent postoperative pain
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who will undergo surgery with spinal anesthesia due to total hip replacement * ASA (American Society of Anesthesiologists) I-II-III patients * Patients aged 65 and over * Patients with a preoperative fasting period of approximately 8 hours
Exclusion criteria
* Refusal to participate in the study * ASA (American Society of Anesthesiologists) score of 4 and above * Body mass index \>40 kg/m²) * Failure of spinal block * Patients who underwent surgery with general anesthesia * Patients who received preoperative and intraoperative sedation * Patients who will undergo revision surgery * Patients with a history of drug use * Patients with psychiatric disorders or those taking antipsychotic medications (depression, bipolar disorder, schizophrenia, etc.) * Patients with central nervous system disease (Alzheimer's disease, Parkinson's disease, multiple sclerosis, etc.) * Patients who do not accept spinal anesthesia and/or pericapsular nerve group (PENG) block * Patients with a preoperative Mini Mental Test (MMT) score below 25 * Patients with contraindications for regional anesthesia techniques * Patients who developed perioperative delirium * Patients with visual or hearing impairment * Patients who require blood or blood product transfusion during surgery * Patients who cannot cooperate in the postoperative period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of postoperative cognitive dysfunction (POCD) | 3 months | The primary outcome of the study was the frequency of postoperative cognitive dysfunction (POCD). Postoperative cognitive function of the patients will be evaluated with telephone versions of the Mini-Mental State Examination (T-MMSE) between 0 and 26 points. Higher scores indicate better cognitive function. POCD was defined as a decline of ≥1 standard deviation (SD) from the baseline T-MMSE score, observed at postoperative day 7, day 30, or day 90. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 11 - point numerical rating scale (NRS) | 3 months | 11-point numerical rating scale for pain (0='no pain' and 10='worst pain possible pain') were explained |
| Mobilization | 3 days | The time from the patient's first assisted mobilization start will be recorded in hours |
| Rescue analgesic requirement | 3 days | Number of additional analgesic applications |
| Discharge time | 7 days | Postoperative hospital discharge time |
Countries
Turkey (Türkiye)
Outcome results
None listed