Femur Fracture, Hip Surgery
Conditions
Keywords
peng block, regional anesthesia, geriatric population
Brief summary
Hip fracture surgery is a common orthopedic procedure, especially in elderly patients. These fractures are quite common in adults over the age of 65, and the one-year mortality rate ranges from 12% to 37%. Recent studies have suggested that general anesthesia and spinal anesthesia are not superior to each other in patients undergoing hip fracture surgery. Untreated/poorly managed perioperative pain is directly linked to delirium, poor prognosis, and secondary chronic pain in hip fracture patients. Therefore, considering the associated mortality, morbidity, and early recovery, control of perioperative pain should be one of the highest priorities of the anesthesiologist, regardless of the anesthesia method used.
Detailed description
Ultrasonography (USG)-guided regional anesthesia techniques are often used as part of multimodal analgesia in the management of perioperative pain in patients with hip fractures. One of the most recently described blocks used in hip fracture surgery, the USG-guided pericapsular nerve group (PENG) block, aims to directly block the articular branch of the femoral nerve, the articular branch of the obturator nerve, and the accessory obturator nerve, which selectively innervates the anterior aspect of the hip capsule. Case reports and a limited number of clinical studies have reported that PENG block is effective in managing acute fracture-related pain, neuraxial anesthesia positioning pain, and postoperative pain in hip fracture patients. In this study, investigators aimed to investigate the effect of USG-guided PENG block on positional pain before spinal anesthesia in patients undergoing surgery for hip fractures and to compare this effect with intravenous ketamine. In addition, investigators aimed to investigate the effect of PENG block on pain scores, perioperative opioid consumption, time to first analgesic requirement in the postoperative period, and quality of recovery in the first 24 hours after surgery.
Interventions
None listed
Sponsors
Marmara University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
hip fracture aged between 35 and 90 years old
Exclusion criteria
contraindications for spinal anesthesia and PENG block impaired cognition or dementia multiple fractures any previous analgesic administration during the last 12 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain scores on the Numeric Rating Scale (NRS) | Group A: 5 minutes after intervention (intravenous opioid), Group B: 20 minutes after intervention (PENG block) | Changes in Numeric Rating Scale (NRS) at rest and on movement will be recorded at intervals. NRS is a unidimensional measure of pain intensity in adults. The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of spinal anesthesia performance | Group A: 5 minutes after intervention (intravenous ketamine), Group B: 20 minutes after intervention (PENG block) | It will be measured in minutes, from the start of positioning maneuvers to the spinal needle removal |
| Quality of patient's position | Group A: 5 minutes after intervention (intravenous ketamine), Group B: 20 minutes after intervention (PENG block) | The position will be characterized as unsatisfactory, satisfactory, good or very good |
| Analgesic consumption | 24 hours | In the postoperative period, patients will be given opioids according to their pain density with a rescue analgesia agent (tramadol). |
Countries
Turkey (Türkiye)
Outcome results
None listed