Comparison of PENG Block and FICB in Hip Fracture Patients

Study Overview
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Brief Summary
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Fascia iliaca compartment block (FICB) has been considered the block of choice for patients with hip fracture. However, pericapsular nerve group (PENG) block, one of the relatively newly-developed blocks, could be also used for analgesia in patients with hip fracture. Since PENG block could block the accessory obturator nerve, PENG block might have greater analgesic effects compared to FICB theoretically. However, the comparison of these two blocks in patients with hip fracture has not performed in clinical setting. Thus, we aimed to compare the analgesic effect of PENG block and FICB.

Official Title
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Comparison of Analgesic Effect of Pericapsular Nerve Group Block and Suprainguinal Fascia Iliaca Compartment Block on Dynamic Pain in Patients Undergoing Hip Fracture Surgery: a Randomized Controlled Trial

Conditions
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Hip Fractures, Regional Anesthesia

Intervention / Treatment
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* Procedure: Pericapsular nerve group (PENG) block
* Procedure: Fascia iliaca compartment block (FICB)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA PS 1-4 age: ≥19 baseline pain score (associated with hip fracture): ≥4 Exclusion Criteria: patients who do not agree to participate in this study patients with uncontrolled hypertension, hyperthyroidism, severe dementia allergic to ropivacaine contraindicated to spinal anesthesia due to coagulopathy, severe aortic stenosis/mitral stenosis, or active infection on lumbar region patients who are considered ineligible with any other reason by investigators

Ages Eligible for Study
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Minimum Age: 19 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PENG group<br>pericapsular nerve group (PENG) block before surgery | Procedure: Pericapsular nerve group (PENG) block<br>* ultrasound-guided PENG block with 0.3% ropivacaine 20cc<br>|
| Active Comparator: FICB group<br>suprainguinal fascia iliaca compartment block (FICB) before surgery | Procedure: Fascia iliaca compartment block (FICB)<br>* ultrasound-guided suprainguinal FICB with 0.3% ropivacaine 30cc<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Efficacy of each block (Pain score) | We will assess the dynamic pain (pain during a movement) using NRS before and 20-30min after applying the assigned block. Then, we will calculate the change of NRS at the two time-points. NRS: Numerical rating scale (0, no pain; 10, the worst pain imaginable) | before surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change of blood pressure (systolic, diastolic, mean blood pressure) | We will evaluate the blood pressure before and 20-30min after applying the assigned block. Then, we will calculate the change of blood pressure at the two time-points. | before surgery | 
| postoperative pain score | resting and dynamic pain using NRS at postoperative 6, 24, 48hours NRS: Numerical rating scale (0, no pain; 10, the worst pain imaginable) | postoperative 6, 24, 48hours | 
| postoperative opioid consumption | morphine-equivalent dose | postoperative 24, 48hours | 
| postoperative motor function | motor function of quadriceps femoris grade5: normal power grade4: movement possible against some resistance grade3: movement against gravity but not resistance grade2: movement possible if gravity eliminated grade1: flicker of contraction possible grade0: complete paralysis | postoperative 6, 24, 48hours | 
| change of heart rate | We will evaluate the heart rate before and 20-30 min after applying the assigned block. Then, we will calculate the change of heart rate at the two time-points. | before surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pericapsular nerve group block, fascia iliaca compartment block, hip fracture, regional anesthesia, dynamic pain