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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.
Patients undergoing elective orthopedic hip surgery will be randomly assigned to one of two groups. Both groups will receive general anesthesia followed by ultrasound-guided nerve blocks. Group 1 will receive a Pericapsular Nerve Group block and a Lateral Femoral Cutaneous Nerve block using 0.25% bupivacaine. Group 2 will receive these same two blocks plus an additional Posterior Pericapsular Deep gluteal block, also using 0.25% bupivacaine.
The primary goal is to evaluate postoperative pain using the Numerical Rating Scale at 6, 12, and 24 hours for both static and dynamic states. Secondary objectives include assessing quadriceps muscle strength using the Lovett Grading Method, measuring total rescue analgesia (nalbuphine) consumption, and monitoring for any complications or differences in length of hospital stay.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Blocks. | Active Comparator | Patients receive ultrasound-guided Pericapsular Nerve Group block and Lateral Femoral Cutaneous Nerve block using 10-15 ml of 0.25% bupivacaine for each block. |
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| Posterior Pericapsular Deep Gluteal, Pericapsular Nerve Group, Lateral Femoral Cutaneous Nerve Block | Experimental | Patients receive ultrasound-guided Pericapsular Nerve Group block, Lateral Femoral Cutaneous Nerve block, and Posterior Pericapsular Deep gluteal block using 10-15 ml of 0.25% bupivacaine for each block. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Posterior Pericapsular Deep Gluteal, Pericapsular Nerve Group, and Lateral Femoral Cutaneous Nerve Blocks. | Procedure | Under 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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). | 6, 12, and 24 hours postoperatively. |
| Measure | Description | Time Frame |
|---|---|---|
| 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). | 1 hour before patient movement. |
| Total Rescue Analgesia Consumption. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Merna H Hilal, MSc, MB Bch | Contact | +201142220555 | Merna.hazem@med.asu.edu.eg | |
| Hany M El Zahaby, MD | Contact | +201227463000 | Hanyzahaby@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University | Cairo | Abbasia | 11591 | Egypt |
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Participants are randomly assigned to one of two groups to receive different regional anesthesia block combinations for postoperative analgesia.
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|
| Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Blocks. | Procedure | Patients receive ultrasound-guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve blocks with 10-15 ml of 0.25% bupivacaine for each block. |
|
Total doses of intravenous nalbuphine (in milligrams) administered to the patient. |
| First 24 hours postoperatively. |
| Length of Hospital Stay. | The total number of days from the date of surgery until hospital discharge. | Approximately 24-72 hours (up to hospital discharge). |
| Occurrence of Postoperative Complications. | Monitoring for nausea, vomiting, dizziness, or infection/hematoma at the puncture site. | First 24 hours postoperatively. |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D015207 | Osteoarthritis, Hip |
| D006620 | Hip Fractures |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
| D007869 | Leg Injuries |
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