Femoral Nerve Block, Periarticular Nerve Group (PENG) Block, and Preoperative IV Fentanyl

NCT ID: NCT06537323

Last Updated: 2025-03-13

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 210 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-06-01
• Study Completion Date: 2025-03-10

Brief Summary

The pericapsular nerve group block is a regional anesthetic technique described in 2018, developed primarily in total hip arthroplasties for postoperative analgesia with motor sparing benefits. The block is thought to provide more complete analgesia to the hip by depositing local anesthetic within the myofascial plane of the psoas muscle and superior pubic ramus. The indications for total hip arthroplasties often include degenerative hip disease and traumatic hip fractures. These indications for surgery are relatively common in the elderly population and are associated with significant morbidity and mortality.

Detailed Description

The pericapsular nerve block is a regional anesthetic technique described in 2018, developed primarily in total hip arthroplasties for postoperative analgesia with motor sparing benefits. The block is thought to provide more complete analgesia to the hip by depositing local anesthetic within the myofascial plane of the psoas muscle and superior pubic ramus.The indications for total hip arthroplasties often include degenerative hip disease and traumatic hip fractures. These indications for surgery are relatively common in the elderly population and are associated with significant morbidity and mortality.Operative intervention, such as total hip arthroplasties has also been associated with significant pain. Historically, the most commonly performed peripheral nerve blocks include lumbar plexus block, a femoral nerve block, or a fascia iliaca compartment block to manage post-operative analgesia. With the understanding that additional articular branches these blocks will provide incomplete analgesia to the hip and may also predispose the patient to fall due to weakness of the quadriceps muscles.Therefore the ideal block technique should provide complete analgesia of the hip joint and without muscle weakness. The ultrasound-guided pericapsular nerve block block allows for coverage of the hip joint, targeting the proximal articular branches that innervate the joint capsule. This proximal approach via ultrasound guidance can confer several advantages over a femoral nerve block by providing more complete analgesia to the hip joint. Additionally, the motor function of the involved extremity should be spared. The pericapsular nerve block block can be used alone as a primary analgesic or in conjunction with other forms of anesthesia during surgery or in the perioperative period. For lateral surgical incisions, a supplemental lateral femoral cutaneous nerve block provides additional coverage.The femoral nerve is among the largest branches of the lumbar plexus. The femoral nerve arises from the ventral rami of the Lumeber 2, Lumber 3, and Lumber 4 spinal nerves, and enters the femoral triangle inferior to the inguinal ligament. The femoral nerve is the most lateral of the structures within the triangle, which also contains the femoral artery and femoral vein at its medial end. The femoral nerve splits into anterior and posterior divisions that originate near the level of the circumflex artery. The anterior division gives rise to the medial femoral cutaneous nerve and innervates the sartorius muscle. The posterior division gives rise to the saphenous nerve and provides innervation to quadriceps femoris muscle. In addition to motor innervation, the femoral nerve provides sensation to the anterior thigh and knee and the medial lower extremity below the knee. The saphenous nerve is a femoral nerve branch that is directly responsible for sensation to the medial lower leg and foot. The saphenous nerve can be blocked separately at the level of the adductor canal, and several more distal sites. The adductor canal is a musculoaponeurotic tunnel found in the mid-thigh and extends from the femoral triangle to the adductor magnus.Due to the anatomical connection, the femoral nerve within the femoral triage may potentially be affected by proximal or high-volume adductor canal blocks.

Conditions

Postoperative Pain

Study Design

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

Study Groups

Femoral nerve block with0.25% bupivacaine

Femoral nerve block with0.25% bupivacaine guided by ultrasound.

Group Type: OTHER

Femoral nerve block with0.25% bupivacaine guided by ultrasound.

Intervention Type: DRUG

Femoral nerve block with0.25% bupivacaine guided by ultrasound.

PENG block with0.25% bupivacaine

PENG block with0.25% bupivacaine guided by ultrasound

Group Type: OTHER

PENG block with0.25% bupivacaine guided by ultrasound.

Intervention Type: DRUG

PENG block with0.25% bupivacaine guided by ultrasound.

Preoperative IV fentanyl

Preoperative IV fentanyl 100microgram

Group Type: OTHER

Preoperative IV fentanyl 100microgram

Intervention Type: DRUG

Preoperative IV fentanyl 100microgram

Interventions

Femoral nerve block with0.25% bupivacaine guided by ultrasound.

Femoral nerve block with0.25% bupivacaine guided by ultrasound.

Intervention Type: DRUG

PENG block with0.25% bupivacaine guided by ultrasound.

PENG block with0.25% bupivacaine guided by ultrasound.

Intervention Type: DRUG

Preoperative IV fentanyl 100microgram

Preoperative IV fentanyl 100microgram

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• The included patient should be between 55 to 69 years

Exclusion Criteria

• known allergies to local anesthetics

• Minimum Eligible Age: 55 Years
• Maximum Eligible Age: 69 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Aswan University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Zaher Zaki Zaher

Lecturer

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Zaher

Cairo, , Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

tarek sayed hemida, md

Role: CONTACT

tarek.said@aswu.edu.eg

00201007363190

Facility Contacts

mostafa tairy adam, md

Role: primary

vdr@med.aswu.edu.eg

00201092991101

Other Identifiers

Aswu 918/5/24

Identifier Type: -

Identifier Source: org_study_id