Comparison between peri‑capsular nerve group and supra inguinal fascia iliaca block for analgesia and ease of positioning during neuraxial anesthesia in hip fracture patients: A randomized double-blind trial

ABSTRACT

Introduction

Patients with fractured hips almost always have marked pain that results in unfavorable positioning for the central neuraxial block. It was revealed that regional block approaches, including suprainguinal fascia-iliaca compartment block (S-FICB) and pericapsular nerve group (PENG) block, might effectively alleviate pain in patients with hip fractures. This research aimed to evaluate the influence of S-FICB and PENG block on patients positioning during central neuraxial block and compare their analgesic efficacy.

Methods

This randomized double-blinded trial included 60 cases aged ≥ 40 years old and ASA I-III with hip fracture with persistent pain and scheduled for surgery under spinal anesthesia (SA). Cases were randomized equally into two groups. Group I (S-FICB) received ultrasound (US) guided S-FICB, and group II (PENG group) received US guided PENG. Both blocks were performed by the same operator using 23 ml of ropivacaine 0.25% + 2 ml (8 mg) of dexamethasone.

Results

The ease of spinal positioning (EOSP) score was significantly better in the PENG group than the S-FICB group (p < 0.001). Twenty minutes after blocks, the numeric rating scale (NRS) reduced significantly in PENG than in SFICB groups at rest (p < 0.015) and movement (p < 0.010). The first request for analgesia, NRS in the first 24-hour period postoperatively, and the number of tramadol doses were similar between both groups (p = 0.552) and (p < 0.370), respectively.

Conclusions

Although each block provides comparable duration of postoperative analgesia, PENG block achieved more analgesic effect and easier positioning than S-FICB for SA in patients who had hip fractures surgery.

KEYWORDS:

• Peri‑capsular nerve group
• supra inguinal fascia iliaca block
• ease of spinal positioning
• analgesia
• neuraxial anesthesia
• hip fracture

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors participated in preparing this clinical trial and approved of the work as it is being submitted. All authors read and approved the final manuscript.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Clinical trial registration

The research was conducted after the approval of the Ethical Committee Benha University Hospitals (approval code: RC 11 March 2023) and registration of clinicaltrials.gov (ID: NCT05987254).

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Each patient supplied informed written consent. The study was carried out with the approval of the Benha University Hospitals Ethical Committee (approval code: RC 11 March 2023), registration of clinicaltrials.gov (ID: NCT05987254).

Additional information

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.