The goal of this intervention study is to compare the analgesic efficacy of pericapsular nerve group (PENG) block versus periarticular anesthetic infiltration (PAI) block in patients undergo hemiarthroplasty after spinal anesthesia .
The main questions it aims to answer are:
which block has more analgesic efficacy. which block has more motor-sparing analgesia.
Researchers will compare optimal motor-sparing analgesia between PENG block and PAI after hemiarthroplasty.
Participants will be divided in two groups :
group receive PENG block and other group receive PAI
None
None
Parallel
PENG block
Procedure/SurgeryThe ultra sound transducer will be placed in a transverse orientation, medial and caudal to the anterosuperior iliac spine in order to identify the anteroinferior iliac spine, the iliopubic eminence and the psoas tendon. Using an in-plane technique and a lateral-to-medial direction, the block needle will be advanced until its tip will be positioned on the periosteum dorsal to the psoas tendon. The LA (20mL of bupivacaine 0.5%) will be injected following negative aspiration.. The accurate position of the needle was confirmed by hydro dissection and spread under the illo-psoas muscle
PAI block
Procedure/SurgeryLA infiltration will be carried out using a total dose of 150mg of bupivacaine and a total volume of 60mL. The admixture (consisting of 60mL of bupivacaine 0.25% and 30mg of ketorolac) will be loaded into two 30mL syringes at the beginning of surgery. After insertion of the acetabular component (and before insertion of the femoral stem), the surgeon will infiltrate the deep tissues (ie, anterior and posterior capsules, gluteus minimus and medius muscles, supraacetabular region, area around the anterior inferior iliac spine, and quadratus femoris muscle all the while avoiding the deep hip external rotator muscle group in order to prevent sciatic nerve block) with the first 30mL syringe. Before wound closure, the gluteus maximus muscle, iliotibial band, subcutaneous tissues, and skin will be infiltrated with the second 30mL syringe.
the pain score (NRS)
the pain score (NRS) after surgery at rest (score 0 =no pain and 10 =worst pain ever) .
the pain score (NRS)
the pain score (NRS) after surgery at rest (score 0 =no pain and 10 =worst pain ever)
Incidence of quadriceps motor block
paresis or paralysis of knee extension) at 3,6,24 hours postoperatively. Knee extension Will be evaluated in a supine position with the patient's hip and knee flexed at 45° and 90°, respectively. The patient will be asked to extend the knee first against gravity and then against resistance. Knee extension will be graded according to a 3-point scale: 0=normal strength (extension against gravity and against resistance); 1=paresis (extension against gravity but not against resistance); 2=paralysis (no extension possible
cumulative morphine consumption in 24 hours.
net total doses of morphine used after surgery
The incidence of block-related adverse events (ie, vascular puncture, LA toxicity).
complication of injection of local anethesia (ie, vascular puncture, toxicity).
Click on the lead sponsor to view all of their trials.
