Effect of Peng Block Application on Inflammation and Mortality in Hip Fractures

Effect of PENG Block on Inflammatory Parameters and Mortality in Geriatric Patients Undergoing Hip Fracture Surgery

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.

Study Overview

• Status: Completed
• Conditions: Inflammatory Response; Hip Fractures; Anesthesia
• Intervention / Treatment: Other: PENG block; Other: Control

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Ankara Bilkent City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• ASA 1-2-3 score
• Hip Fracture Surgery

Exclusion Criteria:

• Refusal to participate in the study
• ASA score of 4 and above
• Obesity (BMI >40)
• Failure of spinal block
• Switching to general anesthesia
• Patients undergoing revision surgery
• Patients with multitrauma
• Patients with old fractures (>3 weeks)
• Patients receiving preoperative and intraoperative sedation
• Patients with active malignancy receiving RT, KT
• Patients with active infection, patients receiving antibiotic treatment
• Patients with contraindications for regional anesthesia techniques
• Patients receiving chronic treatment with steroids or immunosuppressants
• Patients using anti-inflammatory drugs

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: PENG Block; 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.	Other: PENG block; 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.
Other: Control; Standard analgesia method will be applied and analgesia will be provided with tramadol hydrochloride and paracetamol.	Other: Control; Standard analgesia method will be applied and analgesia will be provided with tramadol hydrochloride and paracetamol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	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"	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

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: burak nalbant, Ankara City Hospital Bilkent

Publications and helpful links

General Publications

• 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.
• 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.

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2025
• Primary Completion (Actual): July 17, 2025
• Study Completion (Actual): August 17, 2025

Study Registration Dates

• First Submitted: January 16, 2025
• First Submitted That Met QC Criteria: January 26, 2025
• First Posted (Actual): January 28, 2025

Study Record Updates

• Last Update Posted (Actual): November 17, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: inflammation; Mortality; Hip fracture; PENG block; SIRI
• Additional Relevant MeSH Terms: Wounds and Injuries; Pathologic Processes; Leg Injuries; Fractures, Bone; Femoral Fractures; Hip Injuries; Pathological Conditions, Signs and Symptoms; Inflammation; Hip Fractures
• Other Study ID Numbers: E2-24-8891

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No