Efficacy of Pericapsular Nerve Group Block

NCT ID: NCT05154318

Last Updated: 2023-12-01

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-11-15
• Study Completion Date: 2024-12-31

Brief Summary

Hip fracture is a common orthpaedic problem especially in elderly population. Fascia iliaca compartment block (FICB) and femoral nerve block are well-established technique as part of peri-operative multimodal analgesia for hip fractures. Reviews have shown peripheral nerve blocks including FICB, femoral nerve block and 3-in-1 block could reduce both pain and opioid consumption compared with systematic analgesia. However, there are also literature suggesting that some nerves that account for the major hip joint sensory innervation are not consistently covered. As a result, a new ultrasound guided regional technique, Pericapsular Nerve Group Block (PENG) was introduced in 2018. The primary aim of this study is to compare the analgesic effect of PENG block and FICB in terms of pain score during post-operative period. It also compares the range of movement, quadriceps power and other parameters related to physical functions of the operated hip as secondary outcomes.

Detailed Description

Hip fracture is a common orthopaedic problem especially in elderly population. The number of hip fractures each year is expected to double from 2.2 million in 2017 to 4.5 million in 2050. It is the commonest reason for elderly to require hospitalisation and emergency operation. Significant morbidities such as pulmonary embolism, pneumonia and bed sore can be resulted from immobility and pain. Hip fracture also contributes to post-operative mortality at a rate about 8% at 1 month and 30% at 1 year.

Fascia iliaca compartment block (FICB) and femoral nerve block are well-established technique as part of peri-operative multimodal analgesia for hip fractures. Cochrane review has shown peripheral nerve blocks including FICB, Femoral nerve block and 3-in-1 block could reduce both pain at 30 minute and opioid consumption compared with systemic analgesia. In particular, FICB is found to be superior to opioids for pain control on movement, preoperative analgesic consumption, time to first analgesic request, and time to perform spinal anaesthesia. However, literature suggests that the obturator nerve is not consistently covered.

The anterior hip capsule which contributes the major hip joint sensory innervation is supplied by femoral nerve (FN), obturator nerve (ON) and accessory obturator nerve (AON). As a result, a novel ultrasound guided regional technique, Pericapsular Nerve Group Block (PENG) was introduced in 2018, targeting the above 3 nerves. This is very important as the obturator nerve is also blocked with this technique. Case reports showed reduction in pain scores compared with baseline 30 minutes after block placement and no clinically evident quadriceps weakness was detected.

Conditions

Acute Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Pericapsular Nerve Group Block

30ml 0.3% Ropivacaine will be injected between psoas muscle and iliopubic eminence.

Group Type: EXPERIMENTAL

Pericapsular Nerve Group Block

Intervention Type: PROCEDURE

Nerve block targeting major hip joint sensory nerves.

Fascia iliaca compartment block

30ml 0.3% Ropivacaine will be injected into fascia iliaca compartment.

Group Type: ACTIVE_COMPARATOR

Fascia iliaca compartment block

Intervention Type: PROCEDURE

Routine nerve block for hip fracture surgery.

Interventions

Pericapsular Nerve Group Block

Nerve block targeting major hip joint sensory nerves.

Intervention Type: PROCEDURE

Fascia iliaca compartment block

Routine nerve block for hip fracture surgery.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• ASA I-II
• Age 18 or above
• Scheduled for hip fracture corrective surgery in Queen Mary Hospital
• Chinese patients
• Able to provide informed oral and written consent
• Abbreviated Mental Test (AMT) 7 or above

Exclusion Criteria

• Patient refusal
• ASA III or above
• Allergy to local anaesthetics, opioids, paracetamol, NSAID including COX-2 inhibitors
• Operation delayed for more than 2 days on admission
• Pre-existing peripheral neuropathy or history of stroke
• Preoperative non-walker
• Pre-existing osteoarthritis of knee (KL grade 4)
• Multiple fractures (additional to hip fracture)
• Sepsis
• Impaired renal function (Defined as preoperative creatinine level >120 μmol or eGFR <50% of normal reference for their age group
• Patient with coagulopathy (Platelet < 100 or INR >1.5)
• Prior surgery at the inguinal or supra-inguinal area

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The University of Hong Kong

OTHER

Sponsor Role: lead

Responsible Party

Dr. Chan Chi-Wing

Dr

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Timmy CW Chan, MBBS

Role: PRINCIPAL_INVESTIGATOR

The University of Hong Kong

Locations

Timmy Chan

Hong Kong, , Hong Kong

Site Status: RECRUITING

Countries

Hong Kong

Central Contacts

Timmy CW Chan, MBBS

Role: CONTACT

Phone: 22555679

Email: timmychancw@gmail.com

Facility Contacts

Timmy Chan, MBBS

Role: primary

Other Identifiers

UW21-382

Identifier Type: -

Identifier Source: org_study_id