Clinical trial NCT05968014: Quality of Recovery After Hip Fracture Surgery: US-guided PENG Block Versus FICB
Official title: Quality of Recovery After Hip Fracture Surgery: Ultrasound-guided Pericapsular Nerve Group Block Versus Fascia Iliaca Compartment Block
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Enhanced Recovery After Surgery
Keywords: hip fracture surgery
PENG block
fascia iliaca compartment block
quality of recovery
Lead sponsor: University Tunis El Manar
Sponsor class: OTHER
First posted: 2023-08-01
Enrollment: 80
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: randomised-controlled trial with two parallel study groups. Participants will be randomised 1:1 to the PENG group or FICB group. The PENG group was treated with PENG block following randomisation, whereas the FICB group received a fascia iliaca compartment block.
Primary purpose: BASIC_SCIENCE

Brief summary: Patients were randomly divided into two groups to receive either ultrasound-guided pericapsular nerve group block (PENG group) or fascia iliaca compartment block (FICB group), using 20 ml of 0.2% ropivacaine

Detailed description: Participants were randomly divided into two groups : group PENG and group FICB, to receive either ultrasound-guided pericapsular nerve group block or fascia iliaca compartment block, using 50 ml of 0.2% ropivacaine.

For the FICB, a linear ultrasound probe was placed in the transverse plane and start scanning at the level of the inguinal crease to identify the femoral artery medially and the femoral nerve lateral to the femoral artery. The iliopsoas muscle should be seen overlying fascia iliaca. The block should be performed proximal to the arterial bifurcation. A 50 mm needle was introduced using an in-plane approach to penetrate the fascia iliaca. The hydro dissection separate the fascia iliaca from the iliac muscle, and a total volume of 20 ml of 0.2% ropivacaine was injected in this created space.

The PENG bloc is performed with a low frequency curvilinear ultrasound probe, which was initially placed in a transverse plane over the antero inferior iliac spine and the aligned with the pubic ramus by rotating the probe counterclockwise approximately 45 degrees. In this view, it is possible to observe the iliopubic eminence, the iliopsoas muscle tendon, the femoral artery and the pectineus muscle. A 100 mm needle was inserted from lateral to medial in an in-plane approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. Negative aspiration should be observed before injection of local anaesthetic and a total volume of 20 ml of 0.2% ropivacaine was injected.

Spinal anesthesia was performed after 20 minutes.

QoR-15 score was assessed before the intervention and 24 hours postoperatively.

Eligibility criteria: Inclusion Criteria:

* patients aged above 65 years
* patients with an american society of anesthesiologists physical status I to III
* patients undergoing hip fracture surgical repair

Exclusion Criteria:

* patients with an american society of anesthesiologists physical status IV or more
* inability or refusal to sign informed consent
* contraindications for regional nerve block or spinal anesthesia
* impaired cognition or dementia

Primary outcomes:
measure: The Quality of Recovery-15 scores at 24 hours postoperatively.
timeFrame: before and 24 hours after surgery
Secondary outcomes:
measure: The strength of the quadriceps
timeFrame: 24 hours after surgery
measure: Visual analogue scale
timeFrame: 24 hours after surgery
Other outcomes:
Locations:
city: Nabeul
country: Tunisia
facility: Nabeul hospital, Mohamed Taher Maamouri
state: Mrezga
Study officials:
affiliation: University Tunis El Manar
name: Chaima Debabi
role: PRINCIPAL_INVESTIGATOR
References: