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In this study, the investigators the effect of PENG block on SIRI (systemic inflammation response index) and 30-day mortality in geriatric patients(over 65 years old) undergoing hip surgery, and the effect on the length of hospital stay.
Patients over the age of 65 who were scheduled for surgery due to hip fracture were included in the study. According to the power analysis, it was estimated that at least 52 patients would be required for adequate statistical power. Initially, a total of 60 patients were assessed for eligibility and planned to be divided into two groups by randomization. Multimodal analgesia was applied to both groups.
The first group (Group P) received a preoperative Pericapsular Nerve Group (PENG) block, while the second group (Group C) did not receive an analgesic block and was given paracetamol and tramadol hydrochloride for analgesia. All patients received spinal anesthesia using 10 mg of hyperbaric bupivacaine.
Preoperatively, IL-6, CRP, and complete blood count (CBC) tests were performed on all patients, and these tests were repeated 4, 24, and 48 hours after the surgical stimulus. At the end of the operation, total blood loss, transfused blood products and their volumes, and operation time were recorded. Postoperatively, NRS pain scores, time to first analgesic requirement, length of hospital stay, and 30-day mortality were evaluated.
Post-Completion Study Flow
After completion of the study, a total of 60 patients were assessed for eligibility as planned. Of these, 2 patients declined to participate. The remaining 58 patients were randomized into two groups.
In Group P, one patient required conversion to general anesthesia during surgery. In Group C, two patients required intraoperative sedation, and one patient required conversion to general anesthesia. Therefore, four patients were excluded from the final analysis.
As a result, the analyses were conducted on 54 patients in total, with 28 patients in Group P and 26 patients in Group C.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PENG Block | Active Comparator | PENG block will be performed before the surgery. For PENG block, patients are in the supine position is deposited. The convex ultrasound probe is initially placed over the anterior superior iliac spine, then the probe moves medially until the femoral artery is visualized. In this view, iliopectineal eminence (IPE), iliopsoas muscle and tendon, femoral artery and iliac muscle are observed. Between the psoas tendon and the IPE 22 gauge 80 mm block needle is guided and 20cc local anesthetic used in % 0.25 bupivacaine is administered by intermittent aspiration. |
|
| Control | Other | Standard analgesia method will be applied and analgesia will be provided with tramadol hydrochloride and paracetamol. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PENG block | Other | For PENG block, patients are in the supine position is deposited. The convex ultrasound probe is initially placed over the anterior superior iliac spine, then the probe moves medially until the femoral artery is visualized. In this view, iliopectineal eminence (IPE), iliopsoas muscle and tendon, femoral artery and iliac muscle are observed. Between the psoas tendon and the IPE 22 gauge 80 mm block needle is guided and 20cc local anesthetic used in % 0.25 bupivacaine is administered by intermittent aspiration. |
| Measure | Description | Time Frame |
|---|---|---|
| SIRI-systemic inflammatory response index | The systemic inflammatory response index (SIRI) is defined as "neutrophil count × monocytes/lymphocyte counts". | Preoperative, Postsurgery 4. 24. 48.hour |
| IL-6 | Measurement of IL-6 level in blood | Preoperative, Postsurgery 4. 24. 48.hour |
| Measure | Description | Time Frame |
|---|---|---|
| CRP | Measurement of CRP level in blood | Preoperative, Postsurgery 4. 24. 48.hour |
| SII | systemic inflammation index (SII) is defined as "platelet count × neutrophil count/lymphocyte count" |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| burak nalbant | Ankara City Hospital Bilkent | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Bilkent City Hospital | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38841577 | Background | Fang Z, Gao B, Wang Z, Chen X, Liu M. Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study. Front Med (Lausanne). 2024 May 22;11:1401443. doi: 10.3389/fmed.2024.1401443. eCollection 2024. | |
| 10512275 | Background | Gentili ME, Mazoit JX, Samii K K, Fletcher D. The effect of a sciatic nerve block on the development of inflammation in carrageenan injected rats. Anesth Analg. 1999 Oct;89(4):979-84. doi: 10.1097/00000539-199910000-00029. |
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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|
| Control | Other | Standard analgesia method will be applied and analgesia will be provided with tramadol hydrochloride and paracetamol. |
|
| Preoperative, Postsurgery 4. 24. 48.hour |
| NLR | neutrophil-to-lymphocyte ratio | Preoperative, Postsurgery 4. 24. 48.hour |
| NRS score | The degree of pain will be measured with numerical rating scale (NRS). All patients' postoperative pain numerical rating scale (NRS-numeric rating scale; 0 = absence of pain, 10 = unbearable pain) will be recorded in both groups. | Postoperative 0-2-8-16-24-36-48 hour |
| Additional analgesic requirement | The time of first postoperative analgesic requirement will be noted. | Postoperative first 24 hour |
| length of hospital stay | total day of hospital stay will be noted | 1 week |
| Mortality | 30-day mortality of patients will be followed. | Postoperative 30 day |
| D007869 |
| Leg Injuries |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |