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To evaluate and compare the effectiveness of the Pericapsular Nerve Group (PENG) block alone versus the PENG block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block in providing adequate analgesia for patient positioning during spinal anesthesia in individuals undergoing surgery for hip fracture.
Hip fractures are common among adult patients and often necessitate urgent surgical intervention. Positioning these patients for spinal anesthesia in sitting position is often difficult due to intense pain from the fracture. PENG block is a novel regional technique that targets the articular branches of the femoral nerve, obturator nerve, and accessory obturator nerve, providing excellent anterior hip analgesia sparing the motor function. It is performed under ultrasound guidance and has shown promising results in perioperative pain management. By combining LFCN block with the PENG block, more complete sensory blockade may be achieved. The effectiveness of this combination has not yet been adequately studied, particularly regarding positioning for spinal anesthesia. Therefore, this trial aims to compare the analgesic efficacy of PENG block alone versus PENG +LFCN block in this specific context.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| group A (PENG BLOCK) | Active Comparator | The patient is positioned supine and hip extended. 3 mL of 2% lidocaine is injected at the insertion site using a hyperechoic needle guided by ultrasound using a low-frequency probe. At the anterior superior iliac spine level, the probe is placed parallel to the inguinal fold, and scanning is performed with a gradual movement of the probe head. When the lower anterior inferior iliac spine is observed, the probe is rotated slightly median until a continuous hyperechoic shadow of the upper pubic ramus is visible. This maneuver help to identify the psoas muscle with a prominent tendon above the pubic ramus. The target is located in the plane between these 2 structures. The pubic ramus should be aligned in the center of the image to target the pubic ramus just inside the anterior inferior iliac spine. A 100-mm nerve block needle can be introduced, and 20 ml of 0.25% of Bupivacaine (10 ml of Bupivacaine 0.5% is added to 10ml of Lidocaine 2%) is administered |
|
| Group B (PENG block and LCFN block) | Active Comparator | in addition to PENG block ( as described before), LFCN block is performed by using a linear array ultrasound probe a cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then the probe is moved in a medial and caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection of 8ml of 0.25% of Bupivacaine (4 ml of Bupivacaine 0.5% is added to 4 ml of Lidocaine 2%) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PENG Block | Procedure | Pericapsular Nerve Group Block |
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| Measure | Description | Time Frame |
|---|---|---|
| To compare the time taken to achieve optimal positioning for spinal anesthesia in both groups | time taken in seconds for positioning for spinal anesthesia 15 minutes post- block | from initiation of patient positioning until optimal positioning is achieved during the spinal anesthesia procedure |
| Measure | Description | Time Frame |
|---|---|---|
| To assess Numerical Rating Pain Score in both groups at 0,5,10 and 15 minutes post block | It refers to the common method used in healthcare where patients rate their pain on a scale from 0 to 10 (0 = No pain 10 = Worst pain imaginable). | at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Maha Salah, lecturer | Contact | +201007269331 | mahata5deer@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University | Recruiting | Cairo | Egypt |
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| LCFN block | Procedure | Lateral Femoral Cutaneous Nerve block |
|
| bupivacaine 0.25%. | Drug | 0.25% of Bupivacaine (Bupivacaine 0.5% is added to Lidocaine 2% in the same volume) |
|
| Xylocaine 2 % | Drug | local infilteration at the insertion site |
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| To assess patient satisfaction and comfort during positioning using Likert scale |
5-Point scale (1=strongly disagree and 5=strongly agree). The participants measure it 15 minutes post- block during positioning for spinal anesthesia |
| during patient positioning 15 minutes after completion of the block |
| To monitor mean arterial blood pressure | Comparing mean arterial blood pressure between the 2 groups by millimeter of mercury (mmhg) at 0,5,10 and 15 minutes post-block. | at baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block |
| To monitor heart rate | Comparing the heart rate ( by beats per minute) in the 2 groups at 0,5,10 and 15 minutes post-block. | At baseline (0 minutes) and at 5,10 and 15 minutes after completion of the block |
| ID | Term |
|---|---|
| D008012 | Lidocaine |
| ID | Term |
|---|---|
| D000083 | Acetanilides |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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