Elderly Patients, Hip Fractures (ICD-10 72.01-72.2), Postoperative Pain Management After Total Hip Arthroplasty, Regional Anesthesia
Conditions
Keywords
PENG Block, Pericapsular Nerve Group Block, Hip Surgery, Geriatric Anesthesia, Analgesia, Visual Analog Scale, Tramadol, Ultrasound-Guided Block, Positioning Pain, Peripheral Nerve Block
Brief summary
Hip fractures are among the most common orthopedic traumas, particularly in elderly patients, and are usually associated with significant pain during positioning for spinal anesthesia. Adequate pain control during positioning can improve patient comfort and facilitate successful administration of anesthesia. The pericapsular nerve group (PENG) block has recently been introduced as a regional anesthesia technique that targets articular branches of the femoral, obturator, and accessory obturator nerves, and has been proposed as a method to reduce pain related to hip fracture positioning. This study is designed to compare the efficacy of preoperative PENG block versus no block in patients undergoing proximal femoral nailing surgery under spinal anesthesia. The primary objective is to assess its effect on positioning pain using visual analog scale (VAS) scores. Secondary objectives include evaluating its impact on postoperative analgesic consumption, time to first rescue analgesic, and potential side effects.
Detailed description
This is a prospective, single-center, randomized controlled trial conducted at the University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital. A total of 60 patients, aged 18-90 years, with ASA I-III status, scheduled for proximal femoral nailing (PFN) surgery due to hip fracture, were enrolled. Patients were randomized into two groups using a sealed-envelope method: PENG Block Group: Received a preoperative ultrasound-guided pericapsular nerve group (PENG) block 30 minutes before spinal anesthesia. Control Group: Received no block prior to spinal anesthesia. Standard spinal anesthesia was performed in both groups. All patients received intravenous paracetamol for postoperative analgesia at regular intervals. Additional analgesia with intravenous tramadol was administered if VAS ≥ 4. The following parameters were collected: Demographics (age, sex, BMI, ASA status, comorbidities) Hemodynamic variables (SBP, DBP, HR, SpO₂) at baseline and during perioperative period VAS scores at baseline, during positioning, and at postoperative time intervals (0, 15, 30 minutes, and 1, 2, 6, 12, and 24 hours) Time to first rescue analgesic Total opioid consumption in the first 24 hours postoperatively Side effects such as nausea, vomiting, or other complications The study aims to test the hypothesis that PENG block can reduce pain during positioning for spinal anesthesia and may improve postoperative analgesia in patients undergoing hip fracture surgery.
Interventions
PROCEDUREPericapsular nerve group (PENG) block
A single-shot PENG block was administered preoperatively using ultrasound guidance. The block was performed with the patient in the supine position, and 20 mL of local anesthetic (0.25% bupivacaine) was injected between the psoas tendon and the superior pubic ramus to achieve analgesia of the anterior hip capsule.
PROCEDUREStandard Spinal Anesthesia (Control)
Patients in this arm were managed according to standard care protocols for spinal anesthesia in hip fracture surgery. No preoperative regional block was performed. Pain scores and postoperative tramadol use were measured for comparison with the experimental arm.
Sponsors
Dr. Lutfi Kirdar Kartal Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Participants and care providers were not blinded due to the nature of the intervention. However, the outcome assessor who recorded VAS scores and postoperative analgesic consumption was blinded to group assignment to reduce potential bias.
Intervention model description
A randomized, parallel-group, controlled trial evaluating the effectiveness of PENG block versus no block in patients undergoing hip fracture surgery under spinal anesthesia.
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 to 90 years * ASA (American Society of Anesthesiologists) physical status classification I-III * Scheduled for proximal femoral nailing due to hip fracture * Able to provide informed consent (or consent provided by a legal representative) * Willingness to comply with study procedures and follow-up assessments
Exclusion criteria
* \- ASA physical status classification IV or V * Refusal to provide informed consent * Coagulopathy or current use of anticoagulant therapy contraindicating neuraxial block * Local infection at the injection site * Known allergy or hypersensitivity to local anesthetic agents * Cognitive impairment or inability to cooperate with study procedures * Severe psychiatric illness preventing reliable pain assessment * Previous surgery or deformity of the hip interfering with block performance * Pregnancy or lactation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity during positioning for spinal anesthesia | During spinal anesthesia positioning (within 15 minutes preoperatively) | Pain scores were recorded using the Visual Analog Scale (VAS; 0-10 cm, where 0 = no pain and 10 = worst pain imaginable) during positioning for spinal anesthesia prior to hip fracture surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative VAS scores | 0-24 hours after surgery | Pain scores were assessed using the Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours postoperatively. |
| Cumulative tramadol requirement in the first 24 hours | 0-24 hours after surgery | The total dose of intravenous tramadol administered for breakthrough pain was recorded for each patient. |
| Time to first request for rescue analgesia | 0-24 hours after surgery | The duration (in hours) between the end of surgery and the first administration of rescue tramadol was recorded. |
| Incidence of adverse events related to anesthesia | Intraoperative to 24 hours postoperatively | Frequency of side effects such as nausea, vomiting, hypotension, and local anesthetic systemic toxicity were documented. |
Countries
Turkey (Türkiye)
Outcome results
None listed