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Hip FracturesNCT05912101

Comparison of the Effects of Pericapsular Nerve Group (PENG), Suprainguinal Fascia Iliaca Compartment (S-FICB) and 3-1 Blocks on Comfort in Positioning for Unilateral Spinal Anesthesia and Postoperative Pain in Hip Fracture Surgery

A study testing Pericapsular Nerve Group Block, Suprainguinal Fascia Compartment Block and 3-1 Block in people with Hip Fractures and Pain Management, run by Bozyaka Training and Research Hospital at 1 site in Turkey (Türkiye).

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Hip fracture is a common cause of surgery, especially in elderly patients. Unilateral spinal anesthesia in hip fracture surgery can prevent the undesirable effects of spinal anesthesia due to sympathetic blockade. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hip Fractures, Pain Management, Pain Postoperative
What is being tested?
Pericapsular Nerve Group Block, Suprainguinal Fascia Compartment Block and 3-1 Block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
90 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Jan 2023to 1 Dec 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years and over
  • American Society of Anesthesiologists Physical Status Classification(ASA) I,II and III
  • Fully oriented and able to cooperate
  • Consented to participate in the study by signing the informed consent form
  • Patients with hip fracture and planned unilateral surgery with spinal anesthesia

Who cannot join

  • Patients under 18 years of age
  • Refusal to participate
  • American Society of Anesthesiologists Physical Status Classification(ASA) IV-V
  • Non-cooperation
  • Coagulopathy or thrombocytopenia
  • Allergic to local anesthetics and analgesics
  • Patients with anatomical abnormalities or active infection at the points of application

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Izmir Bozyaka Training and Research Hospital

    Izmir, Karabaglar, 35170

Other trials in Turkey (Türkiye)

About this study

Hip fracture is a common cause of surgery, especially in elderly patients. Unilateral spinal anesthesia in hip fracture surgery can prevent the undesirable effects of spinal anesthesia due to sympathetic blockade.

However, severe pain in hip fracture patients limits the positioning required for unilateral spinal anesthesia. The sedation and analgesia required to position patients with fractured hip remains inferior may cause respiratory depression, hemodynamic instability or postoperative cognitive impairment, especially in elderly patients. Lower extremity peripheral blocks can be used preoperatively to minimize the use of sedatives that may be required during positioning and to provide effective and safe analgesia.

Read the detailed description

In the study, one anesthesiologist (Anesthesiologist A) will perform the relevant peripheral blocks according to the groups to which the patients are randomized; the other anesthesiologist (Anesthesiologist B) will perform unilateral spinal anesthesia in all patients blinded to the peripheral blocks.

On the day of surgery, the patients will first be taken to the block application room and standard monitoring (ECG, pulse oximetry, noninvasive blood pressure) will be applied in the supine position. In the pre-block period, individual pain assessment will be performed with the Visual Analog Scale (VAS - 0 cm = no pain / 10 cm = unbearable pain) and recorded on the case report form. After the pain assessment, disinfection of the block area will be performed with 10% povidone iodine (Batidex) in accordance with surgical sterilization rules. After sterilization, the relevant peripheral block will be performed by Anesthesiologist A under USG guidance. Intermittent negative aspiration will be performed during all interventions to detect possible vascular puncture. All groups will receive 30 ml of local anesthetic solution containing 5 mcg/ml adrenaline and bupivacaine at 0.25% concentration.

Group 1 (PENG Block): Convex USG Probe (1-5 mHz) is placed transversely on SIAS (Spina Iliaca Anterior Superior). The probe is then rotated 45 degrees and aligned with the pubic ramus. In this position, the iliopubic eminence, ilipsoas muscle-tendon, femoral artery and pectineus muscle are observed. A 100 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial to the musculofascial plane with the psoas tendon in front and the pubic ramus behind and the injection is performed.

Group 2 (Suprainguinal Fascia Iliaca Compartment Block) : Linear USG Probe (7-13 mHz) is placed parasagittal to obtain an image of the SIAS. The probe is then shifted medially to identify the fascia iliaca, iliac muscle, internal oblique muscle and deep circumflex iliac artery. A 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is advanced in-plane from caudal to cephalic and injected between the fascia iliaca and iliac muscle.

Group 3 (3-1 Block) Linear USG Probe (7-13 mHz) is placed at the femoral fold and femoral vein-arterial-nerve is visualized. The femoral nerve is located below the fascia iliaca. At this point, a 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial and injected lateral to the femoral nerve. After injection, pressure is applied distal to the needle entry site to spread the local anesthetic proximally in the nerve sheath.

The VAS score of the patients will be reevaluated and recorded during positioning for unilateral spinal anesthesia 30 minutes after the block is performed. Patients with VAS > 3 will be administered sedoanalgesia with propofol - ketamine combination as rescue analgesia before spinal anesthesia and recorded in the case report form. (1 = need sedoanalgesia / 2 = no need sedoanalgesia) Unilateral spinal anesthesia will be administered by Anesthesiologist B after the patient is positioned so that the fractured hip remains at the bottom. The quality of the patient's position will be evaluated by Anesthesiologist B administering spinal anesthesia and recorded on the case report form (0 = inadequate, 1 = adequate, 2 = good, 3 = optimal) All patients will be routinely administered 1000 mg acetominophen 3x1 in the postoperative period.

All patients will be followed up in terms of VAS score and possible opioid requirement in the postoperative 24 hours and evaluated in terms of satisfaction with the procedure.

Patients will be monitored for 24 hours in terms of undesirable side effects and if signs of vascular puncture, hematoma, LA toxicity are observed, these events will be recorded in the case report form and serious adverse reactions will be reported.

Being tested
Pericapsular Nerve Group Block, Suprainguinal Fascia Compartment Block, 3-1 Block
Keywords
Hip Fracture, Unilateral Spinal Anesthesia, Pericapsular Nerve Group Block, 3-1 Block, Suprainguinal Fascia Iliaca Compartment Block, Pain Management
Medical subject headings
Hip Fractures, Agnosia, Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Pericapsular Nerve Group BlockProcedure or surgery

    A convex USG Probe (1-5 mHz) is placed transversely on the SIAS (Spina Iliaca Anterior Superior). The probe is then rotated 45 degrees and aligned with the pubic ramus. In this position, the iliopubic eminence, ilipsoas muscle-tendon, femoral artery and pectineus muscle are observed. A 100 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial to the musculofascial plane with the psoas tendon in front and the pubic ramus behind and the injection is performed.

  • Suprainguinal Fascia Compartment BlockProcedure or surgery

    A linear USG probe (7-13 mHz) is placed parasagittal to obtain an image of the SIAS. The probe is then shifted medially to identify the fascia iliaca, iliac muscle, internal oblique muscle and deep circumflex iliac artery. A 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is advanced in-plane from caudal to cephalic and injected between the fascia iliaca and iliac muscle.

  • 3-1 BlockProcedure or surgery

    A linear USG probe (7-13 mHz) is placed at the level of the femoral fold and the femoral vein-arterial-nerve is visualized. The femoral nerve is located below the fascia iliaca. At this point, a 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial and injected lateral to the femoral nerve. After injection, pressure is applied distal to the needle entry site to spread the local anesthetic proximally in the nerve sheath.

Study groups in NCT05912101
Study groupRoleWhat they receive
Group 1 (PENG)ExperimentalA convex USG Probe (1-5 mHz) is placed transversely on the SIAS (Spina Iliaca Anterior Superior). The probe is then rotated 45 degrees and aligned with the pubic ramus. In this position, the iliopubic eminence, ilipsoas muscle-tendon, femoral artery and pectineus muscle are observed. A 100 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial to the musculofascial plane with the psoas tendon in front and the pubic ramus behind and the injection is performed.
Receives: Procedure: Pericapsular Nerve Group Block
Group 2 (S-FICB)ExperimentalA linear USG probe (7-13 mHz) is placed parasagittal to obtain an image of the SIAS. The probe is then shifted medially to identify the fascia iliaca, iliac muscle, internal oblique muscle and deep circumflex iliac artery. A 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is advanced in-plane from caudal to cephalic and injected between the fascia iliaca and iliac muscle.
Receives: Procedure: Suprainguinal Fascia Compartment Block
Group 3 (3-1)ExperimentalA linear USG probe (7-13 mHz) is placed at the level of the femoral fold and the femoral vein-arterial-nerve is visualized. The femoral nerve is located below the fascia iliaca. At this point, a 50 mm 21G block needle (Stimuplex A®:B. Braun Melsungen AG, Japan) is inserted in-plane from lateral to medial and injected lateral to the femoral nerve. After injection, pressure is applied distal to the needle entry site to spread the local anesthetic proximally in the nerve sheath.
Receives: Procedure: 3-1 Block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Positional Pain in Unilateral Spinal Anesthesia

    Pain in the pre-block period and during unilateral spinal anesthesia positioning after the block will be evaluated by VAS score.

    Measured: 30 minutes after the block is performed

Secondary outcomes (7)
  1. Position Quality in Unilateral Spinal Anesthesia

    The quality of the patient position will be assessed by Anesthesiologist B who administers spinal anesthesia and is blind to the blocks performed (0 = insufficient, 1 = sufficient, 2 = good, 3 = optimal)

    Measured: 30 minutes after the block is performed

  2. The Necessity for Sedoanalgesia for Positional Pain in Unilateral Spinal Anesthesia

    The necessity for sedoanalgesia for pain in the unilateral spinal anesthesia position will be assessed by the Anesthesiologist B who administers spinal anesthesia and is blind to the blocks performed. Rescue sedoanalgesia (propofol - ketamine combination) will be applied to patients with VAS >3. Patients will be recorded as 1 = needing sedoanalgesia, 2 = not needing sedoanalgesia.

    Measured: 30 minutes after the block is performed

  3. Postoperative Pain

    Postoperative pain at 2nd, 6th, 12th and 24th hours will be evaluated using VAS by Anesthesiologist B who is blind to the blocks performed.

    Measured: Postoperative 2nd, 6th, 12th and 24th hours

  4. The Time Until First Opiod Requirement

    Within the first 24-hour-period, as soon as the VAS >3, intravenous opiod (1 mg/kg Tramadol) will be administered and time to first opioid requirement will be recorded.

    Measured: Postoperative first 24-hour-period

  5. Postoperative First 24-hour-period Total Opioid Consumption

    Total opioid (tramadol) consumption in the first 24 hours postoperatively will be recorded in mg/kg/day.

    Measured: Postoperative first 24-hour-period

  6. Patient and Surgeon Satisfaction

    Patient and surgeon satisfaction will be evaluated as: 1 = Complete dissatisfaction, 2 = Moderate dissatisfaction, 3 = Moderate satisfaction, 4 = Complete satisfaction

    Measured: Immediately after the surgery

  7. Undesirable Side Effects

    Recorded when there is vascular puncture, hematoma, signs of LA toxicity.

    Measured: Postoperative first 24-hour-period

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jun 2023
  2. Study start1 Jan 2023
  3. Primary completion1 Nov 2023
  4. Study completion1 Dec 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
90 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05912101
Sponsor's protocol ID
2022/49 ArdaTez
Status last verified
Jun 2023
First submitted
11 Jun 2023
Last updated
14 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.

    PubMed 30063657
  • Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011 Apr;66(4):300-5. doi: 10.1111/j.1365-2044.2011.06628.x. Epub 2011 Feb 24.

    PubMed 21401544
  • Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the "3-in-1 block". Anesth Analg. 1973 Nov-Dec;52(6):989-96. No abstract available.

    PubMed 4796576

Questions about this trial

What is this clinical trial studying?

A study testing Pericapsular Nerve Group Block, Suprainguinal Fascia Compartment Block and 3-1 Block in people with Hip Fractures and Pain Management, run by Bozyaka Training and Research Hospital at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 14 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Positional Pain in Unilateral Spinal Anesthesia (time frame: 30 minutes after the block is performed). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05912101, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Nov 2023.

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