Pericapsular Nerve Group Block Versus Fascia Iliaca Block for Pediatric Hip Surgery

Study Overview
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Brief Summary
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This compares the postoperative analgesic effect of ultrasound-guided pericapsular nerve group block (PENG) with ultrasound-guided fascia iliaca compartment block in pediatric patients undergoing hip surgery.

Detailed Description
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Surgeries involving hip joints in pediatric patients are associated with severe intraoperative and postoperative pain despite the use of systemic opioids. Caudal block is the most commonly used method of regional anesthesia in children to control intraoperative and postoperative pain in surgeries involving lower limbs. However, there have been many side effects of caudal block such as hypotension, urine retention, excessive motor block, technical failure, nausea, and vomiting which may limit its use. There are several techniques of ultrasound-guided regional anesthesia that are used to control acute pain in hip surgery with fewer side effects such as a lumbar plexus block, femoral nerve block, or a fascia iliaca compartment block. The fascia iliaca compartment block (FICB) was described in 1989. It remains a popular regional anesthetic technique for surgical procedures involving the hip joint and femur. Local anesthetic (LA) is injected proximally beneath the fascia iliaca to block the femoral nerve (FN), obturator nerve (ON), and lateral cutaneous nerve of the thigh (LCNT) simultaneously. The pericapsular nerve group (PENG) block was introduced to block the articular branches of the femoral, obturator, and accessory obturator nerves which provide sensory innervation to the hip. This regional anesthetic technique was described in 2018 for acute analgesia related to hip fractures.

Official Title
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Comparison of Ultrasound-Guided Pericapsular Nerve Group Block Versus Ultrasound-Guided Fascia Iliaca Block for Pediatric Hip Surgery

Conditions
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Hip Surgery, Pericapsular Nerve, Fascia Iliaca

Intervention / Treatment
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* Procedure: Caudal Block group
* Procedure: Pericapsular nerve group block
* Procedure: Fascia iliaca group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pediatric patients aged 1-6 years old both sexes, American Society of Anesthesiologists (ASA) physical activity class I-II scheduled for elective hip surgery under general anesthesia. Exclusion Criteria: Children with the severe systemic disease with American Society of Anesthesiologists physical activity class III or IV. Children with previous neurological or spinal disorders. Coagulation disorder. Infection at the block injection site. History of allergy to local anesthetics.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 6 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Caudal Block group<br>25 patients will receive ultrasound-guided caudal block with bupivacaine 0.25% (0.5 mL/kg) after induction of anesthesia. | Procedure: Caudal Block group<br>* Patients will be placed in the lateral decubitus position. After local sterilization with povidone-iodine, the sacral hiatus will be visualized at the level of the sacral Cornus by ultrasound. The needle will be advanced toward the upper third of the sacrococcygeal ligament. The needle advancement will be terminated immediately after penetrating the sacrococcygeal ligament. At this level, after confirming the absence of blood or cerebrospinal fluid on aspiration, bupivacaine 0.25% (0.5 mL/kg) will be injected over 1 minute<br>|
| Experimental: Pericapsular nerve group block<br>25 patients will receive ipsilateral ultrasound-guided Pericapsular nerve group block with bupivacaine 0.25% (0.5 mL/kg) after induction of anesthesia. | Procedure: Pericapsular nerve group block<br>* Patients will receive ultrasound-guided Pericapsular nerve group block in the supine position after proper sterilization of the groin region. The needle will be inserted in-plane with the transducer. The Pericapsular nerve group block group will receive 0.5 mL/kg of (0.25%) bupivacaine after a negative aspiration<br>|
| Experimental: Fascia iliaca group<br>25 patients will receive ipsilateral ultrasound-guided Fascia iliaca compartment block with bupivacaine 0.25% (0.5 m. L/kg) after induction of anesthesia. | Procedure: Fascia iliaca group<br>* Patients will receive Ultrasound-Guided fascia iliaca compartment block in the supine position after sterilization of groin area. The needle will be inserted in-plane with the transducer. The needle tip will be advanced through the fascia iliaca and inserted further cephalad just below the fascia iliaca into the iliacus muscle. 0.5 mL/kg of (0.25%) bupivacaine will be injected and visualized moving cephalad away from the needle tip<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Opioids consumption | Total Opioids consumption in first 24 hour postoperatively will be recorded | 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain | Postoperative pain which will be assessed by face, legs, activity, and cry consolability scale [FLACC] | At post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours. | 
| Time to first rescue analgesia | Time of administration of first rescue analgesia will be recorded. | 24 hours Postoperatively | 
| Adverse effects | Adverse effects: hypotension, Bradycardia, hematoma, and local anesthetic toxicity will be observed and treated accordingly. | 24 hours Postoperatively | 
| Heart rate | Perioperative heart rate will be observed | Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours | 
| Mean arterial blood pressure | Perioperative mean arterial blood pressure will be observed | Intraoperative then at post anesthesia care unit then after 30 minutes 2, 4, 6, 12, 24 hours. |