Anesthesia, Hip Fractures, Inflammatory Response
Conditions
Keywords
PENG block, inflammation, SIRI, Mortality, Hip fracture
Brief summary
In this study, the investigators the effect of PENG block on SIRI (systemic inflammation response index) and 30-day mortality in geriatric patients(over 65 years old) undergoing hip surgery, and the effect on the length of hospital stay.
Detailed description
Patients over the age of 65 who were scheduled for surgery due to hip fracture were included in the study. According to the power analysis, it was estimated that at least 52 patients would be required for adequate statistical power. Initially, a total of 60 patients were assessed for eligibility and planned to be divided into two groups by randomization. Multimodal analgesia was applied to both groups. The first group (Group P) received a preoperative Pericapsular Nerve Group (PENG) block, while the second group (Group C) did not receive an analgesic block and was given paracetamol and tramadol hydrochloride for analgesia. All patients received spinal anesthesia using 10 mg of hyperbaric bupivacaine. Preoperatively, IL-6, CRP, and complete blood count (CBC) tests were performed on all patients, and these tests were repeated 4, 24, and 48 hours after the surgical stimulus. At the end of the operation, total blood loss, transfused blood products and their volumes, and operation time were recorded. Postoperatively, NRS pain scores, time to first analgesic requirement, length of hospital stay, and 30-day mortality were evaluated. Post-Completion Study Flow After completion of the study, a total of 60 patients were assessed for eligibility as planned. Of these, 2 patients declined to participate. The remaining 58 patients were randomized into two groups. In Group P, one patient required conversion to general anesthesia during surgery. In Group C, two patients required intraoperative sedation, and one patient required conversion to general anesthesia. Therefore, four patients were excluded from the final analysis. As a result, the analyses were conducted on 54 patients in total, with 28 patients in Group P and 26 patients in Group C.
Interventions
OTHERPENG block
For PENG block, patients are in the supine position is deposited. The convex ultrasound probe is initially placed over the anterior superior iliac spine, then the probe moves medially until the femoral artery is visualized. In this view, iliopectineal eminence (IPE), iliopsoas muscle and tendon, femoral artery and iliac muscle are observed. Between the psoas tendon and the IPE 22 gauge 80 mm block needle is guided and 20cc local anesthetic used in % 0.25 bupivacaine is administered by intermittent aspiration.
OTHERControl
Standard analgesia method will be applied and analgesia will be provided with tramadol hydrochloride and paracetamol.
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ASA 1-2-3 score * Hip Fracture Surgery
Exclusion criteria
* Refusal to participate in the study * ASA score of 4 and above * Obesity (BMI \>40) * Failure of spinal block * Switching to general anesthesia * Patients undergoing revision surgery * Patients with multitrauma * Patients with old fractures (\>3 weeks) * Patients receiving preoperative and intraoperative sedation * Patients with active malignancy receiving RT, KT * Patients with active infection, patients receiving antibiotic treatment * Patients with contraindications for regional anesthesia techniques * Patients receiving chronic treatment with steroids or immunosuppressants * Patients using anti-inflammatory drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SIRI-systemic inflammatory response index | Preoperative, Postsurgery 4. 24. 48.hour | The systemic inflammatory response index (SIRI) is defined as neutrophil count × monocytes/lymphocyte counts. |
| IL-6 | Preoperative, Postsurgery 4. 24. 48.hour | Measurement of IL-6 level in blood |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NLR | Preoperative, Postsurgery 4. 24. 48.hour | neutrophil-to-lymphocyte ratio |
| NRS score | Postoperative 0-2-8-16-24-36-48 hour | The degree of pain will be measured with numerical rating scale (NRS). All patients' postoperative pain numerical rating scale (NRS-numeric rating scale; 0 = absence of pain, 10 = unbearable pain) will be recorded in both groups. |
| CRP | Preoperative, Postsurgery 4. 24. 48.hour | Measurement of CRP level in blood |
| length of hospital stay | 1 week | total day of hospital stay will be noted |
| Mortality | Postoperative 30 day | 30-day mortality of patients will be followed. |
| Additional analgesic requirement | Postoperative first 24 hour | The time of first postoperative analgesic requirement will be noted. |
| SII | Preoperative, Postsurgery 4. 24. 48.hour | systemic inflammation index (SII) is defined as platelet count × neutrophil count/lymphocyte count |
Countries
Turkey (Türkiye)
Outcome results
None listed