Pericapsular Nerve Block in Proximal Femoral Fractures

Study Overview
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Brief Summary
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Proximal femoral fractures commonly occur above 50 years and regional anesthesia could be a complement in the perioperative treatment of the patients. The use of pericapsular nerve group block (PENG Block) has been proposed to reduce pain. However, no studies have explored the efficient of the systemic analgesia associated with PENG Block in functional limitation in the preoperative period. In this sense, the main goal of this study is to evaluate the effectiveness of systemic analgesia associated with PENG Block in patients with proximal femoral fractures in the period preceding the surgical procedure.

Detailed Description
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Focus on functional capacity will be measured by the Activity Measure for Post-Acute Care (AM-PAC) short version of the 6 Clicks, pain intensity will be assessed using the numerical rating scale, and opioid consumption. This study will include 21 patients admitted to the Emergency Room with proximal femoral fractures.

Official Title
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Effect of Systemic Analgesia and Systemic Analgesia Associated With Pericapsular Nerve Block in Proximal Femoral Fractures

Conditions
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Femoral Fracture

Intervention / Treatment
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* Procedure: PENG Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with unilateral proximal femoral fractures admitted to the emergency room of the Hospital Sírio-Libanes, aged 18-105 years with the American Society of Anesthesiology (ASA) physical status I, II, or III. Exclusion Criteria: allergy to metamizole and/or ropivacaine history of mental disorders presence of chronic pain as assessed using the Douleur Neuropathique 4 (DN4) questionnaire

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 105 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PENG Block<br>Patients will be submitted to PENG block intervention guiding by ultrasound. | Procedure: PENG Block<br>* Patient will be placed in the supine position and the ultrasound probe will be placed in the transverse plane over the anterior inferior iliac spine (AIIS) and aligned with the pubic ramus by rotating the probe counterclockwise by approximately 45 degrees. A 22-gauge, 100 mm needle will be inserted using the plane approach from lateral to medial, between the psoas tendon anteriorly and the pubic ramus posteriorly. Following a negative aspiration, 20 mL of 0.375% ropivacaine will be injected. The needle position will be confirmed by visualizing the separation of layers with the dispersion of the injected volume.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional impairment | The Short-form of Activity Measure for Post-Acute Care (AM-PAC- 6 clicks) is a measure of basic patient mobility will be used. Higher scores mean better outcomes. Minimum 6 points, maximum 26 points. | Before the intervention | 
| Functional impairment | The Short-form of Activity Measure for Post-Acute Care (AM-PAC- 6 clicks) is a measure of basic patient mobility will be used. Higher scores mean better outcomes. Minimum 6 points, maximum 26 points. | 12 hours after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain levels | The Numeric Rating Scale will be used to evaluate pain levels. Higher scores mean worst. outcomes. Minimum 0 point, maximum 10 points. | Before performing the PENG block | 
| Pain levels | The Numeric Rating Scale will be used to evaluate pain levels. Higher scores mean worst. outcomes. Minimum 0 point, maximum 10 points. | 1 hour after performing the PENG block | 
| Pain levels | The Numeric Rating Scale will be used to evaluate pain levels. Higher scores mean worst. outcomes. Minimum 0 point, maximum 10 points. | 12 hours after performing the PENG block | 
| Opioid consumption | The total opioid consumption will be evaluated 24 hours after performing the PENG Block | 24 hours after performing the PENG Block |