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Ultrasound-Guided PENG Block vs Femoral Nerve Block for Analgesia Before Spinal Anesthesia in Hip Fracture Surgery

ConditionsProximal Femur FractureHip FracturePain ManagementSpinal Anesthesia
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorAin Shams University

About this trial

This study will compare two types of ultrasound-guided nerve blocks-Pericapsular Nerve Group (PENG) block and Femoral Nerve Block (FNB)-to evaluate their effectiveness in reducing pain before spinal anesthesia in patients who will undergo surgery for proximal femur fractures. Proximal femur fractures will continue to be common, especially in older adults, and often will cause severe pain that will make it difficult to position patients for spinal anesthesia. Both nerve blocks will aim to reduce pain, improve comfort during spinal anesthesia, and decrease the need for postoperative pain medication.

A total of 60 adult patients who will undergo proximal femur fracture fixation under spinal anesthesia will be enrolled and randomly assigned to receive either a Pericapsular Nerve Group (PENG) block or a femoral nerve block before the procedure. The study will monitor patients' pain scores using the Visual Analog Scale (VAS) at multiple time points, including during positioning and throughout the first 24 hours after surgery. It also will evaluate how long it will take before the patients require rescue pain medication, and how much total pain medication will be needed.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age ≥ 18 years

Scheduled for proximal femur fracture fixation under spinal anesthesia

Classified as American Society of Anesthesiologists (ASA) physical status I, II, or III

Ability to understand and use the Visual Analog Scale (VAS)

Disqualifiers

Coagulopathy

Local infection at the injection site

Known allergy to local anesthetics or magnesium sulfate

Severe cardiopulmonary disease [American Society of Anesthesiologists (ASA) ≥ IV]

Trial design

Design model

Parallel

Treatments tested in this trial

  • Pericapsular Nerve Group (PENG) Block

    Procedure/Surgery

    Assigned Interventions: Procedure/Surgery: Pericapsular Nerve Group (PENG) Block An ultrasound-guided nerve block targeting articular branches of the femoral, obturator, and accessory obturator nerves. Performed under aseptic technique using a curved low-frequency ultrasound probe to visualize the iliopsoas plane and pubic ramus. Drug: Bupivacaine (0.25%, 30 ml) Local anesthetic used to provide analgesia in nerve block. Drug: Magnesium sulfate (10%, 5 ml = 500 mg) Adjunct used to enhance analgesic efficacy of the block.

  • Femoral Nerve Block (FNB)

    Procedure/Surgery

    An ultrasound-guided nerve block targeting the femoral nerve to provide analgesia before spinal anesthesia in proximal femur fracture surgery. Administered using 30 ml of 0.25% bupivacaine and 5 ml of 10% magnesium sulfate (500 mg). The block is performed with an in-plane ultrasound approach, identifying the femoral nerve lateral to the femoral artery under sterile conditions.

Treatment groups

60 Participants
are divided into 2 treatment groups
Group A: PENG Block GroupExperimental treatment 1 intervention
Group B: Femoral Nerve Block GroupActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Pain Score During Positioning for Spinal Anesthesia Using Visual Analog Scale (VAS)

The Visual Analog Scale (VAS) will be used to assess pain intensity during positioning for spinal anesthesia. The VAS is a 10 cm line where 0 indicates no pain and 10 indicates the worst imaginable pain. The score will be recorded immediately before spinal anesthesia after performing either the PENG block or femoral nerve block.

Time frame
Immediately before spinal anesthesia (within 15 minutes post-block)
2

Time to First Rescue Analgesia

The time (in hours) from the end of the nerve block to the first request for additional analgesia (nalbuphine 0.2 mg/kg IV) will be recorded for each patient.

Time frame
Within 24 hours postoperatively

Secondary outcomes

1

Total Nalbuphine Consumption

The cumulative dose (in mg) of intravenous nalbuphine administered for pain control will be calculated for each participant over the first 24 hours following surgery.

Time frame
24 hours postoperatively
2

Mean Arterial Pressure (MAP) Changes

Mean arterial pressure will be recorded at baseline (pre-block), then at 2, 5, 10, 15 minutes post-block, and subsequently at 2, 6, 12, 18, and 24 hours after surgery to evaluate hemodynamic stability following either pericapsular nerve block (PENG) block or femoral nerve block.

Time frame
From baseline up to 24 hours postoperatively
3

Patient Satisfaction Score

Patient satisfaction with pain control will be evaluated using a 5-point Likert scale (1 = very dissatisfied, 5 = very satisfied) at the end of the 24-hour postoperative period.

Time frame
At 24 hours postoperatively

Other outcomes

Locations

This trial has no locations.

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Ain Shams University

Lead sponsor

Source ClinicalTrials.gov

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