Pain Relief Comparison: Pericapsular Nerve Group Versus Quadratus Lumborum Block for Positioning in Femur Fracture Surgery

NCT06917807 | Completed DMC

• 1 other identifier: MD02/2024/2025
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to compare the analgesic efficacy of Ultrasound Guided Pericapsular Nerve Group Block and Quadratus Lumborum Block for pain relief During patient Positioning for Spinal Anesthesia in proximal femur fracture surgeries. A total of 42 patients enrolled and randomly assigned to either the PENG or QLB group (n=21 each). pain relief will be assessed using the visual analog scale (VAS) at rest and during movement before and after the block, as well as the time of first rescue analgesia and total analgesic consumption. the study will also evaluate the ease of spinal positioning and anesthesiologist satisfaction. patient will be monitored intraoperatively and postoperatively for pain scores. adverse events, and analgesic requirement.

Conditions

Acute Post Operative Pain; Hip Fracture; Regional Anaesthesia; Quadratus Lumborum Block

Keywords

regional anesthesia; pain managment; QLB block; PENG block; Hip fracture; postoperative analgesia; nerve block; opioid sparing anesthesia; acute pain control; clinical trial

Outcome Measures

Primary Outcomes (1)

• difference in dynamic visual analog scale (VAS - D) scores at 30 minutes post. - block

  comparison of median reduction in VAS - D scores ( during 15 - degree limb elevation ) between ultrasound - guided pericapsular nerve group block and quadratus lumborum block at 30 minutes after block administration. scale: VAS ( 0 - 10 cm; 0 = no pain, 10 = worst pain )

  baseline ( pre - block ) to 30 minutes post block.

Secondary Outcomes (5)

• ease of spinal positioning score (EOSP)

  immediately before spinal anesthesia ( 30 minutes post - block )

• operator satisfaction score

  immediately after spinal anesthesia placement.

• postoperative pain score

  first 24 hours post - surgery

• time of first rescue analgesia

  up to 24 hours post - block

• total rescue analgesia consumption

  first 24 hours post - surgery

Study Arms (2)

Pericapsular nervegroup block

ACTIVE COMPARATOR

the regional block will be performed with the patient in the supine position. Ultrasound machine with low frequency curvilinear probe (2-5MHz) covered with sterile sheath will be initially placed in a transverse plane over the Anterior Inferior Iliac Spine (AIIS) and then aligned with the pubic ramus by rotating the probe counter-clockwise approximately 45 degrees. In this view, the Iliopectineal Eminence (IPE), the iliopsoas muscle and tendon, the femoral artery, and pectineus muscle will be observed. A 22-gauge, 80-mm needle will be inserted from lateral to medial to place the tip in the musculofascial plane between the psoas tendon anteriorly and the pubic ramus posteriorly. Following negative aspiration, the local anaesthetic solution (30ml of bupivacaine 0.25%) will be injected in 5-mL increments while observing for adequate fluid spread in this plane, without exceeding the toxic dose (3 mg/kg)

Procedure: Pericapsuler nerve group block

Quadratus lumborum block

ACTIVE COMPARATOR

the block will be performed with the patient in the supine position. Under ultrasound guidance with a low frequency curvilinear probe (2-5MHz) covered with sterile sheath, the prob will be placed in coronal plane at midaxillary line between subcostal margin and iliac crest. A 22-gauge, 80-mm needle will be inserted distal to subcostal margin and advanced under curvilinear probe. The needle will be advanced through external oblique aponeurosis, internal oblique, and transversus abdominis muscles. Visualizing the tip penetrating the posterior epimysium of QLM and entering anterior thoracolumbar fascia (ATLF). A small volume of local anaesthetic will be injected after locating the needle tip and a negative aspiration for blood. After the distribution of the local anesthetic will be seen, the rest of the 30 mL of 0.25 % of bupivacaine will be injected

Procedure: Quadratus lumborum block

Interventions

Pericapsuler nerve group block PROCEDURE

A single shot pericapsular nerve group block preformed under ultrasound guidance with a local anesthetic agent ( Marcaine )

Pericapsular nervegroup block

Quadratus lumborum block PROCEDURE

A single shot Quadratus lumborum block preformed under ultrasound guidance with a local anesthetic agent ( Marcaine )

Quadratus lumborum block

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients aging \> 21 years of both sexes.
• Patients scheduled for fixation of proximal femur fracture under spinal anesthesia.
• ASA Physical Status Class I, II or ш.

You may not qualify if:

• Patient refusal to participate.
• Patients receiving opioids for chronic analgesic therapy.
• in ability to comprehend the visual analog scale.
• Coagulopathy ( INR \> 1.4, platelets \< 80000/mm3, or bleeding disorder).
• Infection at the injection site.
• Allergy to local anesthetics.
• Polytroma patients ( e.g., concurrent major thoracic/ abdominal injuries)
• Severe cardiopulmonary disease (e.g., low fixed cardiac output, NYHA class 3/4).
• Neurological disease (e.g., peripheral neuropathy, multiple sclerosis).

Sponsors & Collaborators

• Ain Shams University: lead

Study Sites (1)

Ain Shams university

Cairo, Abassya, 00202, Egypt

Location

MeSH Terms

Conditions

Pain, Postoperative; Hip Fractures

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 6, 2025
• First Posted: April 9, 2025
• Study Start: April 10, 2025
• Primary Completion: October 10, 2025
• Study Completion: January 10, 2026
• Last Updated: February 10, 2026

Record last verified: 2026-02

Locations

EG (1)