Effect of Bupivacaine Concentration on Ultrasound Guided Pericapsular Group Nerve Block Efficacy in Hip Surgery Patients
Condition: Perioperative Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      Fractures in and around the hip are quite common irrespective of both the young and elderly
      population groups and are associated with extreme pain.The anterior hip capsule is innervated
      by articular branches of femoral nerve, obturator nerve and accessory obturator nerve (AON)
      as reported by previous anatomic studies, suggesting that these nerves should be the main
      targets for hip analgesia, which can be blocked by Peri-capsular nerve group (PENG).
    

Detailed description: 
      Fractures in and around the hip are quite common irrespective of both the young and elderly
      population groups and are associated with extreme pain. A hip fracture is a serious injury,
      with complications that can be life-threatening and is a common orthopedic emergency in the
      elderly. Early surgery within 48 h of fracture has shown to decrease the complication and
      mortality rates.

      Spinal anaesthesia is the most common mode of anaesthesia used to fix these fractures.
      Extreme pain due to fracture does not allow ideal positioning for these procedures. and hence
      a problem to access the subarachnoid space. Inadequate postoperative analgesia can restrict
      the limb mobility thereby delaying recovery along with increased consumption of opioids.

      Effective perioperative analgesia that reduces the requirement of opioids and its adverse
      effects is essential in this population.

      The anterior hip capsule is innervated by articular branches of femoral nerve, obturator
      nerve and accessory obturator nerve (AON) as reported by previous anatomic studies,
      suggesting that these nerves should be the main targets for hip analgesia, which can be
      blocked by Peri-capsular nerve group (PENG) .

      PNB with lower volume and higher concentration of local anesthetic was more efficacious than
      higher volumes and lower concentrations of local anesthetic of equivalent dose.

      Using this information, the investigators will conduct this study to evaluate the efficacy of
      bupivacaine at three different concentration and doses in equivalent volume used in
      ultrasound guided PENG block for positioning & post-operative analgesia.
    

Intervention name(s): Bupivacain
Intervention type(s): Drug
Intervention description(s): The blocks will be performed in supine position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, "LOGIQ E") will be initially placed in a transverse plane over the anterior superior iliac spine (ASIS) and then alignes to identify the following landmarks: Anterior inferior iliac spine, ilio-pubic eminence, iliopsoas muscle and tendon, the femoral artery, and Pectineus muscle. Point of injection will be musculo-fascial plane between the psoas tendon and ilio-pubic eminence.
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: pain; positioning; PENG block