This study aims to investigate the efficacy of adding a Posterior Pericapsular Deep gluteal block to two other standard nerve blocks-the Pericapsular Nerve Group block and the Lateral Femoral Cutaneous Nerve block-for patients undergoing orthopedic hip surgery. While standard blocks target the front of the hip, many patients still feel pain in the back (posterior) of the joint. Researchers will compare two groups of patients to see if this triple-block combination provides better pain relief and reduces the need for rescue opioid medications in the 24 hours following surgery.
Age greater than or equal to 18 years.
Both genders included.
American Society of Anesthesiologists (ASA) physical status classification I-III.
Undergoing elective orthopedic hip surgery.
Patient refusal of procedure or participation.
American Society of Anesthesiologists (ASA) physical status classification IV.
Allergy to any of the drugs used in the study.
Local skin infection at the injection site.
Parallel
Posterior Pericapsular Deep Gluteal, Pericapsular Nerve Group, and Lateral Femoral Cutaneous Nerve Blocks.
Procedure/SurgeryUnder ultrasound guidance, patients receive a Pericapsular Nerve Group block, a Lateral Femoral Cutaneous Nerve block, and a Posterior Pericapsular Deep gluteal block. For each of the three blocks, 10-15 ml of 0.25% bupivacaine is injected while observing for adequate fluid spread over the respective anatomical targets.
Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Blocks.
Procedure/SurgeryPatients receive ultrasound-guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve blocks with 10-15 ml of 0.25% bupivacaine for each block.
Evaluation of Postoperative analgesic effect through Numerical Rating Scale Pain Score.
Evaluation of postoperative analgesic effect through the Numerical Rating Scale for both static and dynamic pain. Static pain is measured after the patient has rested in bed for 15 minutes. Dynamic pain is measured with the hip joint flexed to 45 degrees. The scale ranges from 0 (no pain) to 10 (worst possible pain).
Quadriceps Femoris Muscle Strength.
Evaluation using the Lovett Grading Method, a manual muscle testing scale from 0 (no contractility) to 5 (complete range of motion against full resistance).
Total Rescue Analgesia Consumption.
Total doses of intravenous nalbuphine (in milligrams) administered to the patient.
Length of Hospital Stay.
The total number of days from the date of surgery until hospital discharge.
Occurrence of Postoperative Complications.
Monitoring for nausea, vomiting, dizziness, or infection/hematoma at the puncture site.
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