PENG Block vs Fascia Iliaca Block for Emergency Department Analgesia in Hip Fractures
Hip Fractures
About this trial
This is an interventional treatment trial for Hip Fractures focused on measuring Fascia iliaca block, PENG block, Regional anaesthesia at Emergency Departments, Hip Fracture Analgesia
Eligibility Criteria
Inclusion Criteria:
- Age >18
- Capacity to understand the aim of the study, the potential benefits and side-effects of the procedures
- Capacity to provide consent
- Capacity to provide a self-assessment of pain using the written VAS Scale
- Confirmed radiological diagnosis of hip fractures (including subcapitate, transcervical, intertrochanteric and perthrocanteric fractures)
- Moderate or severe worst pain (visual analogue scale, VAS >40 mm) (at rest or dynamic)
Exclusion Criteria:
- Known hypersensitivity to local anaesthetics
- Confirmed radiological diagnosis of subtrochanteric or diaphyseal femur fractures
- Hemodynamic instability
- Known diagnosis of severe cognitive impairment
- Dementia and/or delirium (defined by a 4AT score ≥ 2)
- Lack of capacity to provide consent and to understand the aim of the study
- BMI>35
- Body weight < 40 Kg
- Prior hip surgery on the same fracture side
- Mild worst pain (visual analogue scale, VAS < 40 mm) (at rest or dynamic)
Sites / Locations
- Emergency Department, IRCCS San Matteo University HospitalRecruiting
- Emergency Department, Colchester General Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Other
PENG block: Study group
Infrainguinal fascia iliaca block: Control group
Patients enrolled in the study group will receive a PENG block with 20 mL of 0,375% levobupivacaine with 4 mg of dexamethasone. The block will be performed with the patient in a supine position using an 18-gauge, 90 mm needle, inserted with an in-plane lateral to medial approach. Operators will use the original technique described by Girón-Arango L et al. The aim of this block is to inject the local anaesthetic between the psoas tendon and the iliopubic eminence. We will instruct operators to routinely use a curvilinear probe (2-6 MHz) or a linear probe (4-16 MHz) in particularly lean or cachectic patients.
Patients allocated in the control group will receive an infrainguinal fascia iliaca block with 30 mL of 0,25 % levobupivacaine with 4 mg of dexamethasone, using an 18-gauge, 90 mm needle, inserted with an in-plane lateral to medial approach. The probe (linear 4-16 MHz) is placed transversely at the inguinal crease to identify the femoral artery, femoral nerve, iliopsoas muscle and the fascia iliaca over the psoas muscle. Moving the probe laterally the sartorius muscle and the anterior inferior iliac spine (AIIS) can be identified. After skin disinfection the needle is inserted placing the tip beneath the fascia iliaca at the lateral third of a line between the AIIS and pubic tubercle. Correct needle placement is confirmed by separation of the fascia iliaca from the iliopsoas muscle upon injection, with local anaesthetic spreading towards the FN medially and the iliac crest laterally.