Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block

Study Overview
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Brief Summary
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assess and compare the efficacy of pericapsular nerve group block wersus lumber erector spinae plane block in reducing postoperative pain within the first 24 hours after hip surgeries.

Detailed Description
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after being informed about the study and potential risks. All patients giving written consent will be randomized by double blind manner into 3groups each one containing 23 patients ,PENG group (n =23 ): The patients will receive Pericapsular Nerve Group Block (PENG Block) before positioning for spinal anesthesia. ESPS group E (n =23 ): The patients will receive Lumbar Erector Spinae Plane Block before positioning for spinal anesthesia. Control group C(n =23 ): patients received spinal anesthesia without any block.

Official Title
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Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block as Postoperative Analgesia in Hip Surgeries: A Randomized Controlled Trial

Conditions
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Pericapsular Nerve Group Block (PENG Block), Lumbar Erector Spinae Plane Block

Intervention / Treatment
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* Procedure: Pericapsular Nerve Block
* Procedure: Lumbar Erector Spinae Plane Block
* Drug: Fentanyl


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 65 to 75 years old. American Society of anesthesiologists physical status II and III. Body mass index of 25 to 30 kg/m2. Exclusion Criteria: Altered mental status. History of trauma or multiple fractures Uncontrolled hypertension and or diabetes. Coagulopathy. Preexisting advanced kidney, liver, or heart disease. Allergies or contraindications to the study drugs. Chronic use of opioids or corticosteroids.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 75 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PENG<br>the patients lied in the supine position. The probe was originally placed in a transverse plane above the anterior superior iliac spine in the ipsilateral surgical site and then counterclockwise rotated about 45 degrees to line up with the pubic ramus. The iliopubic eminence, iliopsoas muscle and tendon, femoral artery, and pectineus muscle were all visible in this view. By an in-plane technique, from lateral to medial, a 22-gauge, 80-mm needle was placed in the musculofascial plane between both the psoas tendon anteriorly and the pubic ramus posteriorly .The local anesthetic medication was delivered after negative aspiration while looking out for proper fluid distribution for a total volume of 20 mL of Bupivacaine 0.25% | Procedure: Pericapsular Nerve Block<br>* regional anaesthia<br>* Other names: PENG;|
| Active Comparator: ESPB<br>TThe patient was positioned at the lateral decubitus posture in the ipsilateral surgical site. The convex USG transducer was moved from the midline to the side of the operation and positioned 4-6 cm lateral to the L3 spinous process in a longitudinal parasagittal plane. The needle was advanced using the in-plane superior-to-inferior approach. The needle was advanced with the tip introduced up to the plane anterior to the erector spinae muscle and the posterior surface of the L3 transverse process. 0.5-1 ml of normal saline was administered for hydrodissection and to ensure proper placement .If there was any resistance during administering local anesthesia, the needle was modified by drawing it back a few millimeters. the prepared local anesthetic solution 20 ml bupivacaine 0.25 % was delivered through the point between both the transverse process and the erector spinae muscle | Procedure: Lumbar Erector Spinae Plane Block<br>* regional anaesthia<br>* Other names: LESB;|
| Placebo Comparator: control<br>patients received spinal anesthesia without any block | Drug: Fentanyl<br>* intavenous<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the time to first postoperative rescue analgesia | the time to ask for the first postoperative analgesia (morphine) when the patient is reporting NRS ≥ 3 | 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Block performance time (min) | time from placement of ultrasound probe on the patient's skin to the end of local anesthetic injection | immediately before surgery | 
| onset of sensory block | the time between the end of the injection of local anesthetic (bupivacaine) and the loss of pin prick sensation using a sterile 25G needle in the operating field. | after the block | 
| pain intensity | using an 11point numeric rating scale (NRS)(11) : 0: no pain,10=worst imaginable pain) 1-3Mild Pain (nagging, annoying, interfering little with activities of daily living (ADLs). 4-6Moderate Pain (interferes significantly with activities of daily living(ADLs) 7-10Severe Pain (disabling; unable to perform ADLs) at rest and during movement (during45-degree passive flexion of the hip with the ipsilateral knee flexed) | 30 minutes after the end of surgery ,3,6,12 hours postoperative. | 
| The total dose of rescue analgesia | The total dose of rescue analgesia | 24 hours postoperative | 
| adverse effects | nausea, vomiting ,hypotension ,bradycardia and hematoma | 24 hours postoperative | 
| Patient satisfaction | related to block performance, post-operative pain relief was evaluated by an 11- point satisfaction score (0=unsatisfied and 10 = most satisfied), and the score was divided as follows 0-3 (not satisfied), 4-6 (partly satisfied), and 7-10 (highly satisfied). | 24 hours postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lumbar Erector Spinae Plane Block, Pericapsular Nerve Group Block (PENG Block)