Comparative Study Between Pericapsular Nerve Group Block (PENG) And Pericapsular Nerve Group (PENG) Block Combined With Lateral Femoral Cutaneous Nerve (LFCN) Block for Positioning Analgesia Prior to Spinal Anesthesia in Hip Fracture Patients

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.

Study Overview

• Status: Recruiting
• Conditions: Hip Fracture Surgeries
• Intervention / Treatment: Procedure: PENG Block; Drug: bupivacaine 0.25%.; Drug: Xylocaine 2 %; Procedure: LCFN block

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maha Salah, lecturer; Phone Number: +201007269331; Email: mahata5deer@gmail.com

Study Locations

• Egypt
  • Cairo, Egypt
    • Recruiting
    • Ain shams university
    • Contact: Maha Salah, lecturer; Phone Number: +201007269331; Email: mahata5deer@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age 18-70 years.
• ASA I-II.
• Confirmed primary unilateral hip fracture.
• Scheduled for surgery under spinal anesthesia.
• Patients able to provide informed consent.

Exclusion Criteria:

• Allergy to local anesthetics.
• Coagulopathy or on anticoagulant therapy.
• Infection at injection site.
• Pre-existing neurological deficits in the lower limbs.
• Multiple trauma or polytrauma (If other injuries might interfere with positioning or pain scoring).
• Previous surgery on the ipsilateral hip affecting anatomy or nerve distribution.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group B (PENG block and LCFN block); 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%)	Procedure: PENG Block; Pericapsular Nerve Group Block; Drug: bupivacaine 0.25%.; 0.25% of Bupivacaine (Bupivacaine 0.5% is added to Lidocaine 2% in the same volume); Drug: Xylocaine 2 %; local infilteration at the insertion site; Procedure: LCFN block; Lateral Femoral Cutaneous Nerve block
Active Comparator: group A (PENG BLOCK); 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	Procedure: PENG Block; Pericapsular Nerve Group Block; Drug: bupivacaine 0.25%.; 0.25% of Bupivacaine (Bupivacaine 0.5% is added to Lidocaine 2% in the same volume); Drug: Xylocaine 2 %; local infilteration at the insertion site

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	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
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

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): June 18, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: June 18, 2026
• First Submitted That Met QC Criteria: July 4, 2026
• First Posted (Actual): July 7, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: PENG block; hip surgeries; positioning for spinal anesthesia; LCFN block
• Additional Relevant MeSH Terms: Organic Chemicals; Anilides; Amides; Aniline Compounds; Amines; Acetanilides; Lidocaine
• Other Study ID Numbers: FMASU MS 25 / 2026

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