PENG Block Versus Fascia Iliaca Block for Pre- and Post-Operative Analgesia in Elderly Patients With Hip Fracture

Study Overview
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Brief Summary
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Clinical controled trial to compare between pericapsular Nerve Group Block and Fascia Iliaca Block to find the best way to provide analgesia for elderly patients with hip fracture in the pre- and post-operative periods.

Detailed Description
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Pain is a major problem that has to be dealt with in case of hip fracture, as it resembles an obstacle for examination, positioning for receiving neuroaxial anesthesia and postoperative mobility and physiotherapy. With the introduction of ultrasound in regional anesthesia and peripheral nerve blocks, regional analgesia float to the surface as a substitute for opioids with less side effects. Of the many techniques to provide regional analgesia for hip fractures; fascia iliaca block was widely used with good results. In 2018 Pericapsular Nerve Group Block was introduced to provide regional analgesia for hip fractures with interesting results. In this study the investigators are going to compare Pericapsular Nerve Group Block and Fascia Iliaca Block to find the best way to provide analgesia for elderly patients with hip fracture in the pre- and post-operative periods.

Official Title
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Pericapsular Nerve Group Block Versus Fascia Iliaca Block for Pre- and Post-Operative Analgesia in Elderly Patients With Hip Fracture

Conditions
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Hip Fractures

Intervention / Treatment
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* Procedure: Pericapsular nerve Group block
* Procedure: Facia Iliaca block
* Drug: Fentanyl


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient acceptance. Accepted mental state of the patient. Gender: both sexes. Age above 65 years old. Body mass index 18.5-35 kg/m2. ASA physical status II and III. Unilateral hip fracture assigned for surgical fixation. Expected duration of surgery ≤ 3 hours. Exclusion Criteria: Associated trauma or multiple fractures. Peripheral neuropathy. Coagulopathy. Infection at site of injection. Allergy to the drugs used in the study. Advanced kidney, liver or heart disease.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group C<br>Patients will be assigned to receive opioids analgesia before spinal anesthesia in the form of intravenous fentanyl in a dose of 1mic/kg divided into two boluses with 5 minutes interval in between before positioning the patient for spinal anesthesia. | Drug: Fentanyl<br>* Intravenous fentanyl in a dose of 1mic/kg divided into two boluses with 5 minutes interval in between.<br>* Other names: Intravenous opioid;|
| Experimental: Group P<br>Patients will be assigned to receive Pericapsular Nerve Group Block (PENG Block) before positioning the patient for spinal anesthesia. | Procedure: Pericapsular nerve Group block<br>* Under ultrasound guidance a needle is inserted between the iliopectineal eminence and the iliopsoas muscle and tendon to block articular branches supplying the capsule of hip joint.<br>* Other names: PENG block;|
| Experimental: Group F<br>Patients will be assigned to receive Fascia Iliaca Block (F.I Block) before positioning for spinal anesthesia. | Procedure: Facia Iliaca block<br>* Under ultrasound guidance a needle is inserted between the fascia iliaca and Psoas muscle to block the femoral, obturator and lateral cutaneous nerves.<br>* Other names: FI block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison between the analgesic effect of both Pericapsular Nerve Group block and Fascia Iliaca block with VAS score. | Analysis of Visual Analogue Pain Score for both PENG block and FI block before and after each block during rest and movement to compare between their analgesic effect. The Visual Analogue Pain score is done by drawing a 10cm vertical line on a piece of paper with its limits no pain (0) on one side and extreme pain (10) on the other side. The patient will be asked to point where the pain (he/she) experiences lies on the line. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PENG block, Hip fracture, analgesia, Fascia Iliaca block, ultrasound, Fentanyl