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Pericapsular Nerve Group Block Versus Femoral Nerve Block Study

16. července 2026 aktualizováno: Taksim Egitim ve Arastirma Hastanesi

Comparison of Preoperative Pericapsular Nerve Group (PENG) Block Versus Femoral Nerve Block for Optimizing Spinal Anaesthesia in Proximal Femur Fracture Surgery: A Prospective Randomized Controlled Trial

Hip fractures are common in older adults and are often associated with severe pain, making it difficult for patients to sit for spinal anesthesia before surgery. Peripheral nerve blocks may improve pain control and facilitate patient positioning, but it remains uncertain whether the Pericapsular Nerve Group (PENG) block provides advantages over the traditional femoral nerve block during the spinal anesthesia procedure.

Přehled studie

Postavení

Zatím nenabíráme

Podmínky

Intervence / Léčba

Detailní popis

Hip fractures are among the most common injuries in older adults and are associated with substantial morbidity, mortality, and healthcare utilization. Spinal anesthesia is frequently used for surgical repair of proximal femur fractures because of its favorable safety profile in elderly patients. However, severe pain caused by the fracture often makes positioning for spinal anesthesia difficult, resulting in patient discomfort, prolonged procedure time, multiple needle insertion attempts, and increased procedural complexity.

Peripheral nerve blocks are increasingly used before spinal anesthesia to improve analgesia and facilitate patient positioning. The femoral nerve block (FNB) has long been established as an effective regional anesthesia technique for patients with hip fractures. More recently, the ultrasound-guided Pericapsular Nerve Group (PENG) block has been introduced as a motor-sparing technique targeting the articular branches of the femoral, obturator, and accessory obturator nerves that innervate the anterior hip capsule. Previous studies have demonstrated that the PENG block provides effective analgesia during positioning for spinal anesthesia and may offer superior pain relief compared with conventional techniques. However, evidence comparing the effects of PENG block and femoral nerve block on the technical performance of spinal anesthesia and perioperative hemodynamic stability remains limited.

This prospective, randomized controlled trial is designed to compare ultrasound-guided PENG block with ultrasound-guided femoral nerve block in patients undergoing surgery for proximal femur fracture under spinal anesthesia. The study will evaluate whether PENG block improves procedural conditions for spinal anesthesia compared with femoral nerve block while also assessing perioperative analgesia and hemodynamic responses.

The study hypothesis is that preoperative PENG block will provide better procedural conditions for spinal anesthesia than femoral nerve block by improving patient positioning, reducing pain during positioning, facilitating spinal needle placement, decreasing the need for supplemental analgesic or sedative medication, and contributing to greater perioperative hemodynamic stability.

Typ studie

Intervenční

Zápis (Odhadovaný)

110

Fáze

  • Nelze použít

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní kontakt

Studijní místa

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

  • Dospělý
  • Starší dospělý

Přijímá zdravé dobrovolníky

Ne

Popis

Inclusion Criteria:

  • Adults aged 50 years or older.
  • Diagnosis of proximal femoral fracture.
  • Scheduled to undergo surgical repair under spinal anesthesia.
  • American Society of Anesthesiologists (ASA) physical status I-III.
  • Able to provide written informed consent.

Exclusion Criteria:

  • Refusal to participate or inability to provide informed consent.
  • Coagulopathy or contraindication to spinal anesthesia or peripheral nerve block.
  • Local infection at the planned injection site.
  • Known allergy or hypersensitivity to local anesthetics.
  • Pre-existing neurological disease affecting lower extremity function or sensory assessment.
  • Cognitive impairment preventing reliable study participation or outcome assessment.
  • Previous lumbar spine surgery.
  • Polytrauma.
  • Body mass index (BMI) <18 kg/m² or >40 kg/m².
  • Current anticoagulant therapy that precludes neuraxial anesthesia or peripheral nerve block according to institutional practice.

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: Randomizované
  • Intervenční model: Paralelní přiřazení
  • Maskování: Trojnásobný

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Aktivní komparátor: PENG Block
Participants will receive a preoperative ultrasound-guided Pericapsular Nerve Group (PENG) block with 20 mL of 0.25% bupivacaine before spinal anesthesia for proximal femur fracture surgery. Spinal anesthesia will subsequently be performed according to the standardized study protocol.
Postup: Ultrasound-Guided Pericapsular Nerve Group (PENG) Block
Ultrasound-guided PENG block performed before spinal anesthesia using 20 mL of 0.25% bupivacaine to provide analgesia for patients undergoing surgery for proximal femur fracture.
Postup: Spinal Anesthesia (bupivacaine)
Standard spinal anesthesia performed after the assigned peripheral nerve block using intrathecal hyperbaric bupivacaine according to the study protocol.
Aktivní komparátor: Femoral Nerve Block
Participants will receive a preoperative ultrasound-guided femoral nerve block with 20 mL of 0.25% bupivacaine before spinal anesthesia for proximal femur fracture surgery. Spinal anesthesia will subsequently be performed according to the standardized study protocol.
Postup: Spinal Anesthesia (bupivacaine)
Standard spinal anesthesia performed after the assigned peripheral nerve block using intrathecal hyperbaric bupivacaine according to the study protocol.
Postup: Ultrasound-Guided Femoral Nerve Block
Ultrasound-guided femoral nerve block performed before spinal anesthesia using 20 mL of 0.25% bupivacaine to provide analgesia for patients undergoing surgery for proximal femur fracture.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Spinal Anesthesia Convenience Score (SACS)
Časové okno: During spinal anesthesia procedure (immediately after patient positioning and before initiation of surgery)
Spinal anesthesia convenience will be assessed using the Spinal Anesthesia Convenience Score (SACS), a composite clinical score evaluating the ease of spinal anesthesia based on anatomical landmark palpation, patient cooperation, sitting position quality, pain during passive hip flexion, and pain while maintaining the sitting position. Total scores range from 0 to 11, with higher scores indicating easier spinal anesthesia conditions.
During spinal anesthesia procedure (immediately after patient positioning and before initiation of surgery)

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
First-Attempt Success of Spinal Anesthesia
Časové okno: During the spinal anesthesia procedure.
The proportion of participants in whom successful intrathecal access is achieved on the first needle insertion attempt.
During the spinal anesthesia procedure.
Number of Spinal Needle Insertion Attempts
Časové okno: During the spinal anesthesia procedure.
The total number of spinal needle insertion attempts required to achieve successful spinal anesthesia.
During the spinal anesthesia procedure.
Duration of Spinal Anesthesia Procedure
Časové okno: During the spinal anesthesia procedure.
Time from the beginning of patient positioning until completion of spinal anesthesia and return to the supine position, measured in minutes.
During the spinal anesthesia procedure.
Anxiety Score
Časové okno: Before peripheral nerve block, 30 minutes after block placement, and immediately before surgical incision (after spinal anesthesia).
Patient anxiety will be assessed using an 11-point Numeric Rating Scale (NRS) ranging from 0 (no anxiety) to 10 (maximum anxiety). Lower scores indicate less anxiety.
Before peripheral nerve block, 30 minutes after block placement, and immediately before surgical incision (after spinal anesthesia).
Patient Satisfaction
Časové okno: Postoperative Day 0 (before discharge from the post-anesthesia care unit [PACU])
Patient satisfaction with the anesthesia process will be assessed using a Numeric Rating Scale ranging from 0 (not satisfied at all) to 10 (completely satisfied). Higher scores indicate greater satisfaction.
Postoperative Day 0 (before discharge from the post-anesthesia care unit [PACU])
Anesthesiologist Satisfaction
Časové okno: Immediately after completion of spinal anesthesia.
The anesthesiologist's satisfaction with procedural conditions will be assessed using a Numeric Rating Scale ranging from 0 (not satisfied at all) to 10 (completely satisfied). Higher scores indicate greater satisfaction.
Immediately after completion of spinal anesthesia.
Perioperative Hemodynamic Parameters
Časové okno: Before peripheral nerve block; 1, 5, 10, 15, and 30 minutes after block placement; and 1, 5, 10, 15, and 30 minutes after spinal anesthesia.
Mean arterial blood pressure will be recorded throughout the perioperative period.
Before peripheral nerve block; 1, 5, 10, 15, and 30 minutes after block placement; and 1, 5, 10, 15, and 30 minutes after spinal anesthesia.
Incidence of Hypotension
Časové okno: From spinal anesthesia until 30 minutes after surgery completed.
Hypotension is defined as a mean arterial pressure below 65 mmHg. The proportion of participants experiencing hypotension will be recorded.
From spinal anesthesia until 30 minutes after surgery completed.
Vasopressor Requirement
Časové okno: From spinal anesthesia until 30 minutes after surgery completed.
Total intravenous ephedrine dose administered for the treatment of hypotension, measured in milligrams.
From spinal anesthesia until 30 minutes after surgery completed.
Additional Analgesic Medication Requirement
Časové okno: During the spinal anesthesia procedure.
Total doses of intravenous fentanyl (micrograms) administered during positioning for spinal anesthesia.
During the spinal anesthesia procedure.
Additional Sedative Medication Requirement
Časové okno: During the spinal anesthesia procedure.
Total doses of intravenous midazolam (milligrams) administered during positioning for spinal anesthesia.
During the spinal anesthesia procedure.

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

Taksim Egitim ve Arastirma Hastanesi

Vyšetřovatelé

  • Vrchní vyšetřovatel: Celal Kaya, Taksim Training and Research Hospital

Publikace a užitečné odkazy

Osoba odpovědná za zadávání informací o studiu tyto publikace poskytuje dobrovolně. Mohou se týkat čehokoli, co souvisí se studiem.

Obecné publikace

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia (Odhadovaný)

20. července 2026

Primární dokončení (Odhadovaný)

10. prosince 2026

Dokončení studie (Odhadovaný)

20. prosince 2026

Termíny zápisu do studia

První předloženo

6. července 2026

První předloženo, které splnilo kritéria kontroly kvality

16. července 2026

První zveřejněno (Aktuální)

21. července 2026

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

21. července 2026

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

16. července 2026

Naposledy ověřeno

1. července 2026

Více informací

Termíny související s touto studií

Klíčová slova

Další relevantní podmínky MeSH

Další identifikační čísla studie

  • E-48670771-514.99-317908988

Plán pro data jednotlivých účastníků (IPD)

Plánujete sdílet data jednotlivých účastníků (IPD)?

NE

Popis plánu IPD

There is no current plan to share individual participant data (IPD). Future data sharing may be considered upon reasonable request and subject to approval by the sponsor, institutional policies, and applicable ethical and legal requirements.

Informace o lécích a zařízeních, studijní dokumenty

Studuje lékový produkt regulovaný americkým FDA

Ne

Studuje produkt zařízení regulovaný americkým úřadem FDA

Ne

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .

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