Ultrasound Percapsular Nerve Group Block VS Fascia Iliaca Block for Hip Fracture

February 11, 2024 updated by: Olfa kaabachi, MD, University Tunis El Manar

Analgesic Techniques Before Spinal Anesthesia for Hip Fracture Repair: Ultrasound Percapsular Nerve Group Block VS Fascia Iliaca Block

Spinal anesthesia (SA) is a widely accepted anesthetic technique for hip fracture repair among elderly. Positioning for SA can be extremely painful. Effective management of pain is important for these patients comfort.

Fascia Iliaca block (FIB) and Femoral nerve blocks are commonly used for analgesia in hip fracture patients. However, they often provide a modest reduction in pain.

The Percapsular Nerve Group block (PENG Block) has the advantage that it covers the accessory obturator nerve.

Aim of the study: compare FIB with PENG prior to positioning hip fracture patients for standardized SA.

In a prospective randomized double blind we included 80 patients aged more than 65 years old, for whom pain was felt when raising the affected limb to 15 degrees. Patients were assigned to receive either ultrasound guided Fascia Iliaca block or Percapsular Nerve Group block using 20 mL Lidocaine 1.5% in both groups. We compared pain on positioning for spinal anesthesia using Verbal Rating Scale (VRS 0 = no pain , VRS 1 = mild pain, t 2= severe pain) for both groups. We also recorded different times to perfom block.

Study Overview

Detailed Description

The purpose of the study was to compare analgesis effect of Percapsula nerve group block to fascia iliaca block prior to positioning hip fracture patients for standardized SA. We included 80 patients reporting pain with Verbal Rating Scale at 2 when raising the affected limb to 15 degrees. All patients admitted to induction room, were given standard monitoring and we randomized to receive either: ultrasound fascia iliaca block using linear high frequency ultrasound probe (10-15MHz) placed in a transverse direction over the anterior thigh below the inguinal ligament. A 50 mm needle was advanced until the tips placed underneath the fascia iliaca and 20 mL 1.5% Lidocaine was injected or ultrasound Percapsula nerve group block A curvilinear using low-frequency ultrasound probe (2-5MHz) that was initially placed in a transverse plane over the anterior inferior iliac spine and then aligned with the pubic ramus by rotating the probe counter clockwise approximately 45 degrees. In this view, the iliopubic eminence , the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle were observed and than a 100 mm needle was advanced to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly and 20 mL 1.5% Lidocaine.We compared pain on positioning for spinal anesthesia and also different time to realise both blocks.

Study Type

Interventional

Enrollment (Actual)

88

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Tunis, Tunisia, 2010
        • Institut Kassab D'Orthopedie

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

65 years and older (Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • - Patients aged ≥ 65 years old and undergoing hip fracture surgical repair under continuous spinal anesthesia (CSA).
  • Patients for whom pain was felt when raising the affected limb to 15 degrees (VERBAL PAIN SCALE =2)

Exclusion Criteria:

  • - ASA physical status ≥ 4.
  • Impaired cognition or Dementia.
  • Multiple fractures.
  • Contraindication to regional anesthesia.
  • Patient's disapproval.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: fascial iliaca
: A linear high frequency ultrasound probe (10-15MHz) was placed in a transverse direction over the anterior thigh below the inguinal ligament. We identified the femoral artery and the iliacus muscle lateral to it, covered by the fascia iliaca. The needle was inserted in plane and a 22 gauge, 50 mm needle was advanced until the tips placed underneath the fascia iliaca. Following negative aspiration, the local anesthetic solution was injected in 5mL increments while observing for adequate fluid spread in this plane for a total volume of 20 mL of 1.5% Lidocaine
ultrasound guided block with 20 mL lidocaine 1.5%
Other Names:
  • BIF for hip fracture
Experimental: Percapsular nerve group block
A curvilinear low-frequency ultrasound probe (2-5MHz) was initially placed in a transverse plane over the anterior inferior iliac spine (AIIS) and then aligned with the pubic ramus by rotating the probe counterclockwise approximately 45 degrees. In this view, the iliopubic eminence (IPE), the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle were observed. A 22-gauge, 100-mm needle was inserted from lateral to medial in an in-plane approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. Following negative aspiration, the local anesthetic solution was injected in 5 mL increments while observing for adequate fluid spread in this plane for a total volume of 20 mL of 1.5% Lidocaine.
ultrasound guided block with 20 mL lidocaine 1.5%
Other Names:
  • PENG block for hip fracture

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
positioning pain
Time Frame: up to 30 minutes
Verbal Rating Scale (VRS) [0=no pain ; 4=worst pain]
up to 30 minutes

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Positioning Rating
Time Frame: up to 40 minutes
verbal rating scale (VRS) [0=no pain ; 4=worst pain]
up to 40 minutes
Imaging time
Time Frame: up to 10 minutes

For the PENG block:the femoral artery, the anterior inferior iliac spine, the iliopubic eminence and the psoas tendon.

For the FIB: the femoral artery, the iliacus muscle, the fascia iliaca and the fascia lata.

up to 10 minutes
Puncture time
Time Frame: up to 10 minutes
the time that stretches from the introduction of the needle until the end of the injection of local anesthetic
up to 10 minutes
Performance time
Time Frame: up to 10 minutes
the imaging time + time to puncture.
up to 10 minutes
Number of punctures
Time Frame: up to 10 minutes
the number of redirection of the needle after removing 2 cm.
up to 10 minutes
pain 5 after block
Time Frame: up to 5 minutes
verbal rating scale (VRS) [0=no pain ; 4=worst pain]
up to 5 minutes
pain 10 after block
Time Frame: up to 10 minutes
verbal rating scale (VRS) [0=no pain ; 4=worst pain]
up to 10 minutes
pain 15 after block
Time Frame: up to 15 minutes
verbal rating scale (VRS) [0=no pain ; 4=worst pain]
up to 15 minutes
pain 20 after block
Time Frame: up to 20 minutes
verbal rating scale (VRS) [0=no pain ; 4=worst pain]
up to 20 minutes

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: khaireddine Raddaoui, MD, Tunis El Manar University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 17, 2020

Primary Completion (Actual)

April 30, 2020

Study Completion (Actual)

May 31, 2022

Study Registration Dates

First Submitted

February 9, 2020

First Submitted That Met QC Criteria

February 23, 2020

First Posted (Actual)

February 26, 2020

Study Record Updates

Last Update Posted (Estimated)

February 13, 2024

Last Update Submitted That Met QC Criteria

February 11, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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