Effects of Pericapsular Nerve Group Block Applied in Patients Undergoing Hip Fracture Surgery.

Study Overview
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Brief Summary
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In this study, it was aimed to compare the multimodal analgesia application or the pericapsular nerve group (PENG) block methods in patients undergoing hip surgery. The effectiveness and benefit rate of the PENG block in postoperative pain will be evaluated. Postoperative pain, need for additional analgesia, range of motion of the hip joint, mobilization time, length of hospital time and adverse events in patients undergoing hip fracture surgery with and without PENG block will be investigated.

Detailed Description
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This prospective randomised controlled study included a total of 70 patients aged 30-85 years who underwent hip fracture surgery under spinal anaesthesia. Patients were randomly divided into two groups using the sealed envelope method, Group I: those who received PENG block (n:35) and Group II:Those who did not receive PENG block (control group) (n: 35). All patients will undergo hip fracture surgery by the same surgical team. Each patient will be informed about the procedure to be performed during anesthesia and surgery, and signed informed consent will be obtained before the procedure.Patients in Group I who will undergo the PENG block method; Before surgery, after spinal anesthesia, PENG block is performed under sterile conditions under ultrasonography guidance. With the patient supine, a 2-5 MHz, low-frequency, curvilinear probe is placed in the transverse plane medial to the anterior inferior iliac spine (AIIS), with the medial end of the probe rotated approximately 45° counterclockwise to align with the superior pubic ramus. With the PENG block, an 80 mm block needle is placed in the fascial plane between the psoas tendon and the pubic ramus and 20 ml of 0.5% bupivacaine is administered. As for the patients in Group II (control group); It is a routine practice at the end of surgery; 10 ml 0.5% bupivacaine + 10 ml 2% lidocaine is infiltrated into the surgical area by the surgical team. For routine postoperative multimodal analgesia, intravenous PCA (patient controlled analgesia) was administered to patients in both groups with tramadol 50 mg at a basal rate of 10 mg / hour after loading (20 mg bolus dose + 30 minutes lock time) and paracetamol 10 mg / kg iv. (Given every 8 hours)

Official Title
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Effects of Pericapsular Nerve Group (PENG) Block Applied for Analgesia on the Postoperative Process in Patients Undergoing Hip Fracture Surgery.

Conditions
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Hip Fractures, Pain, Postoperative

Intervention / Treatment
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* Procedure: Pericapsular Nerve Group (PENG) Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who will undergo hip fracture surgery Women and men aged 30-85 Exclusion Criteria: Patients under 30 years old, over 85 years old American Society of Anesthesiology (ASA) IV, Those with cognitive impairment (alzheimer, dementia, delirium, etc.) Those with application site infection Those who are allergic to local anesthetic substances Patients are non-consenting patients.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 85 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
Interventional Model Description: This prospective randomised controlled study included a total of 70 patients aged 30-85 years who underwent hip fracture surgery under spinal anaesthesia. Patients were divided into two groups as PENG block and non-PENG block (control group).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PENG Block group<br>PENG block group; USG probe is placed on the transverse plane medial to the anterior inferior iliac spine (AIIS), the medial end of the probe is placed on the superior pubic It is rotated approximately 45° counterclockwise to align it with the ramus. For the PENG block, an 80 mm block needle is placed in the fascial plane between the psoas tendon and pubic ramus and 20 ml of 0.5% bupivacaine is administered after spinal anesthesia, | Procedure: Pericapsular Nerve Group (PENG) Block<br>* Pericapsular nerve group (PENG) block The femoral nerve and obturator nerve terminal branches, which provide sensory innervation of the hip joint, are blocked, thus providing analgesia without creating a motor block.<br>|
| Other: Control group<br>Control group; 10 ml 0.5% bupivacaine + 10 ml 2% lidocaine is infiltrated into the surgical area by the surgical team at the end of surgery | Procedure: Pericapsular Nerve Group (PENG) Block<br>* Pericapsular nerve group (PENG) block The femoral nerve and obturator nerve terminal branches, which provide sensory innervation of the hip joint, are blocked, thus providing analgesia without creating a motor block.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain score | VAS pain score | 30 min, 12th, 24th and 48th hours in the postoperative period | 
| Total opioid consumption | Tramadol (mg) | postoperative 48 hours | 
| mobilisation time | take 5 steps with walker | postoperative 24-48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PENG block adverse events | motor block, nerve damage, hypotension, bradycardia | between the time surgery starts and the 48th hour | 
| length of hospital stay | day | between the time of hospitalization for the operation and discharge (day) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PENG block, Anesthesia