Hip Fractures, Hip Osteoarthritis, Postoperative Pain
Conditions
Keywords
Posterior Pericapsular Deep Gluteal Block, Pericapsular Nerve Group Block, Lateral Femoral Cutaneous Nerve Block, Ultrasound-Guided Regional Anesthesia, Multimodal Analgesia, Orthopedic Hip Surgery
Brief summary
This study aims to investigate the efficacy of adding a Posterior Pericapsular Deep gluteal block to two other standard nerve blocks-the Pericapsular Nerve Group block and the Lateral Femoral Cutaneous Nerve block-for patients undergoing orthopedic hip surgery. While standard blocks target the front of the hip, many patients still feel pain in the back (posterior) of the joint. Researchers will compare two groups of patients to see if this triple-block combination provides better pain relief and reduces the need for rescue opioid medications in the 24 hours following surgery.
Detailed description
Patients undergoing elective orthopedic hip surgery will be randomly assigned to one of two groups. Both groups will receive general anesthesia followed by ultrasound-guided nerve blocks. Group 1 will receive a Pericapsular Nerve Group block and a Lateral Femoral Cutaneous Nerve block using 0.25% bupivacaine. Group 2 will receive these same two blocks plus an additional Posterior Pericapsular Deep gluteal block, also using 0.25% bupivacaine. The primary goal is to evaluate postoperative pain using the Numerical Rating Scale at 6, 12, and 24 hours for both static and dynamic states. Secondary objectives include assessing quadriceps muscle strength using the Lovett Grading Method, measuring total rescue analgesia (nalbuphine) consumption, and monitoring for any complications or differences in length of hospital stay.
Interventions
PROCEDUREPosterior Pericapsular Deep Gluteal, Pericapsular Nerve Group, and Lateral Femoral Cutaneous Nerve Blocks.
Under ultrasound guidance, patients receive a Pericapsular Nerve Group block, a Lateral Femoral Cutaneous Nerve block, and a Posterior Pericapsular Deep gluteal block. For each of the three blocks, 10-15 ml of 0.25% bupivacaine is injected while observing for adequate fluid spread over the respective anatomical targets.
PROCEDUREPericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Blocks.
Patients receive ultrasound-guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve blocks with 10-15 ml of 0.25% bupivacaine for each block.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Participants are randomly assigned to one of two groups to receive different regional anesthesia block combinations for postoperative analgesia.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age greater than or equal to 18 years. * Both genders included. * American Society of Anesthesiologists (ASA) physical status classification I-III. * Undergoing elective orthopedic hip surgery. * Provision of written informed consent.
Exclusion criteria
* Patient refusal of procedure or participation. * American Society of Anesthesiologists (ASA) physical status classification IV. * Allergy to any of the drugs used in the study. * Local skin infection at the injection site. * Coagulation disorder. * History of cardiac arrhythmia, seizures, or increased intracranial tension. * Alcohol or drug abuse, or psychiatric disease. * History of chronic pain.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of Postoperative analgesic effect through Numerical Rating Scale Pain Score. | 6, 12, and 24 hours postoperatively. | Evaluation of postoperative analgesic effect through the Numerical Rating Scale for both static and dynamic pain. Static pain is measured after the patient has rested in bed for 15 minutes. Dynamic pain is measured with the hip joint flexed to 45 degrees. The scale ranges from 0 (no pain) to 10 (worst possible pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quadriceps Femoris Muscle Strength. | 1 hour before patient movement. | Evaluation using the Lovett Grading Method, a manual muscle testing scale from 0 (no contractility) to 5 (complete range of motion against full resistance). |
| Total Rescue Analgesia Consumption. | First 24 hours postoperatively. | Total doses of intravenous nalbuphine (in milligrams) administered to the patient. |
| Length of Hospital Stay. | Approximately 24-72 hours (up to hospital discharge). | The total number of days from the date of surgery until hospital discharge. |
| Occurrence of Postoperative Complications. | First 24 hours postoperatively. | Monitoring for nausea, vomiting, dizziness, or infection/hematoma at the puncture site. |
Countries
Egypt
Contacts
CONTACTMerna H Hilal, MSc, MB Bch
CONTACTHany M El Zahaby, MD
Outcome results
None listed