Our aim will be to investigate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound guided pericapsular nerve group (PENG) block for postoperative analgesia in hip replacement surgeries.
* Our primary outcome of the study: total amount of postoperative morphine consumption in the first 24h postoperative. * Our secondary outcome of the study: postoperative analgesia assessed by pain score (by Visual Analog Scale)
Patients aged from 18 years to 90 years
Gender : both males and females
BMI less than 35 kg/m2
Patients with American society of anesthesiologists (ASA) classification class I , II or III
Patient declining to give written informed consent
Patient with infection at the site of injection
Patient with coagulopathy
Patients with known allergy to used medications.
Parallel
Ultrasound guided Pericapsular Nerve Group Block
Procedure/SurgeryWith the patient in the supine position and the leg slightly abducted, a curvilinear transducer (2.5-7.5 MHz) is prepared with sterile conduction gel and covered with a sterile probe cover. The transducer is placed transversely over the anterior superior iliac spine (ASIS), then aligned with the pubic ramus and rotated approximately 45° parallel to the inguinal crease. The probe is slid medially to identify key landmarks: the anterior inferior iliac spine (AIIS), iliopubic eminence (IPE), iliopsoas tendon, femoral artery, and femoral nerve. Sliding the probe distally or tilting caudally exposes the femoral head. A 20-22 gauge echogenic needle (100 mm) is inserted in-plane from lateral to medial, targeting the plane between the psoas tendon and the pubic ramus. the anesthetic agent is deposited to lift the psoas tendon while avoiding tendon puncture.
Isobaric Bupivacaine 0. 25%
Druggroup c will receive PENG block with only 20ml isobaric bupivacaine 0.25%
20 ml isobaric bupivacaine 0.25% and 1.5μg/kg dexmedetomidine
Druggroup D will receive PENG block with 20 ml isobaric bupivacaine 0.25% and 1.5μg/kg dexmedetomidine
the ultrasound machine with curvilinear transducer (high -frequency probe, 2.5Mhz to 7.5Mhz)
Devicethe two groups will receive the PENG block under ultrasound guidance
a standard echogenic 20-22 gauge 100mm needle
Devicethe two groups will receive the PENG block using a standard echogenic 20-22 gauge 100mm needle
total amount of postoperative morphine consumption in the first 24h postoperative.
the intensity of postoperative pain assessed by the Visual Analog Scale for pain
the intensity of postoperative pain assessed by the Visual Analog Scale for pain , which was scored from 0 to 10 where 0= no pain and 10 = the worst pain imaginable at 0,2,4,6,8,10,12,16,24 hours post-operatively to evaluate acute pain
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