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The aim of the study to Evaluate the efficacy of nalbuphine-bupivacaine vs dexamethasone-bupivacaine in ultrasound guided pericapsular nerve group (PENG) block for improving pain management, reducing opioid consumption, and enhancing the overall analgesic effect in patients undergoing hip surgeries.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group Bupivacaine + nalbuphine (N) | Active Comparator | Patients in this group will receive a unilateral ultrasound-guided pericapsular nerve group (PENG) block with a combination of 20 mL of bupivacaine 0.25%- and 2 ml nalbuphine (20 mg), with total volume 22ml |
|
| Group Bupivacaine + dexamethasone (D) | Active Comparator | Patients in this group will receive a unilateral ultrasound-guided PENG block with a combination of 20 mL of bupivacaine 0.25%- , 1 ml dexamethasone (4 mg) and 1 ml saline, with total volume 22ml |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group Nalupnine | Procedure | Patients will receive a unilateral ultrasound-guided pericapsular nerve group (PENG) block with a combination of 20 mL of bupivacaine 0.25%- and 2 ml nalbuphine (20 mg), with total volume 22ml. |
| Measure | Description | Time Frame |
|---|---|---|
| The time to first request of rescue analgesia | (time from end of local anesthetics injection in PENG block till time of NRS >3) will be recorded. | 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| postoperative pain by Numerical Rating Scale | To assess pain score by using numerical rate scale (NRS) at rest (static) and during passive flexion or extension of hip (dynamic) at different time points | Basal (before giving the block), 15 minutes after giving the block and before spinal anesthesia, PACU ( after arrival to PACU 0 minute), 2 hours (hrs), 4 hrs, 8 hrs, 12 hrs and 24 hrs. |
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Inclusion criteria:
Patients acceptance.
Age: Adults aged 21-75 years old.
BMI: 25-30 kg/m2
Sex: both sexes (males or females).
Patients undergoing unilateral hip surgery under spinal anesthesia.
ASA (American Society of Anesthesiologists) physical status classification I, II and â…¢..
*Exclusion criteria:
Patients with contraindications to regional anesthesia (e.g. local or systemic infections, or severe neurological or muscular disorders or patient on anticoagulant).
Allergy to study drugs: bupivacaine or nalbuphine or dexamethasone
Patients with severe cardiovascular, respiratory, renal, or hepatic conditions, uncontrolled diabetes diseases, or those undergoing chronic opioid therapy.
Psychiatric disorders that hinder informed consent or study participation.
history of neurological diseases or conditions that would affect the efficacy of nerve blocks (e.g., neuropathy, spinal cord injury, or history of severe muscle weakness).
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculity of medicine, Zagazig university, Zagazig | Zagazig | Egypt |
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Evaluate the efficacy of nalbuphine-bupivacaine vs dexamethasone-bupivacaine in ultrasound guided pericapsular nerve group (PENG) block for improving pain management, reducing opioid consumption, and enhancing the overall analgesic effect in patients undergoing hip surgeries
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Anesthetist not sharing in the study will assess patient
| Group Dexamethasone | Procedure | Patients will receive a unilateral ultrasound-guided PENG block with a combination of 20 mL of bupivacaine 0.25%- 1 ml dexamethasone (4 mg) and 1 ml saline, with total volume 22ml |
|
| To assess the total amount of rescue analgesic consumption | To assess the total amount of rescue analgesic consumption in the first 24 hours post-operatively in each group | 24 hours postoperative |
| To assess the incidence of drug-related side effects or block -related side effects | To assess the incidence of drug-related side effects (such as nausea, vomiting, respiratory depression and hyperglycemia) or block -related side effects (hematoma, infection or LA toxicity) in patients receiving either nalbuphine or dexamethasone as adjuvant to bupivacaine in the PENG block. | 24 hours postoperative |
| Ease of Spinal Positioning (EOSP) | evaluated on a scale from zero to three (zero = unable to be positioned; one = abnormal posture of the patient due to pain requiring support for positioning; two = mild discomfort but no need for assisted positioning; three = optimal condition where the patient could sit without feeling pain) | up to 15 minutes after giving the block |
| patient's satisfaction | overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) | 24 hours postoperative |
| Number of patients received one or two doses rescue analgesia | Number of patients received one or two doses rescue analgesia (pethidine) postoperative | 24 hours |
| Length of hospital stay | number of hospital stay days starting from PACU discharge till home discharge | up to 5 days |
| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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