ULTRASOUND GUIDED PERICAPSULAR NERVE GROUP BLOCK VERSUS SUPRAINGUINAL FASCIA ILIACA COMPARTMENT BLOCK FOR EASE OF POSITIONING DURING SPINAL ANAESTHESIA FOR HIP FRACTURE SURGERIES: A RANDOMIZED CONTROLLED STUDY

Abstract

Background Hip fractures represent a significant clinical challenge, particularly in the elderly, due to the associated morbidity and the necessity for timely surgical intervention. Perioperative pain management is vital in ensuring patient comfort, enabling optimal positioning for subarachnoid block (SAB), and improving perioperative outcomes. Among the various regional anaesthesia techniques, Pericapsular Nerve Group (PENG) block and Suprainguinal Fascia Iliaca Compartment Block (S-FICB) have gained popularity for their effectiveness in managing preoperative pain. Despite their increasing use, direct comparative data on the relative benefits of these two blocks remain scarce. Objectives The purpose of this study was to check the effectiveness of ultrasound-guided PENG block compared to S-FICB in people undergoing surgery for hip fractures. Those outcomes considered were patient positioning, the level of discomfort during positioning, stable blood pressure during surgery and how well postoperative pain was managed. Methods Adult patients with hip fractures (72 in total) who underwent procedures using spinal anaesthesia were part of this study. People were divided at random into Group A (PENG Block) and Group B (S-FICB). The procedures were carried out using ultrasound and all the technicians followed the same guidelines on how to do them and use drugs. Before and during the block, the Visual Analog Scale (VAS) was measured - first at rest (VAS-R) and then again during movement (VAS-M) - at several intervals: before the block (T0), at 5 minutes (T5), 15 minutes (T15) and at the time of SAB positioning (S0). While the procedure and surgical intervention was underway, the ASA monitor was used to watch over the heart rate and mean arterial pressure, to see how the patient responded. How xvii quickly analgesia was provided and the amount of paracetamol and tramadol consumed during postoperative care were recorded to check on postoperative analgesia. Results VAS scores decreased significantly after administration of both blocks, indicating effective pain control. The PENG group exhibited slightly lower average VAS scores at T5, T15, and S0 as compared to those of S-FICB group; however, these differences were not of statistical significance. Hemodynamic parameters remained stable in both groups throughout the observation period, although a modest reduction in heart rate was noted in the S-FICB group during the initial measurements. The quantity of analgesics consumed postoperatively and the timing of first rescue medication were comparable between the two groups. Importantly, no complications or adverse effects related to the blocks were reported. Conclusion Ultrasound-guided PENG and S-FICB blocks are both reliable in providing good perioperative analgesia in patients with hip fractures. While the overall effectiveness and hemodynamic profiles were similar, the PENG block showed a trend toward quicker onset and improved pain relief during positioning for SAB. Its anatomical precision and potential for preserving motor function may offer advantages, especially in older patients or those at risk for postoperative mobility delays. These findings advocate for the inclusion of the PENG block in perioperative care strategies, particularly within Enhanced Recovery After Surgery (ERAS) protocols. Further research involving larger and more diverse patient populations is recommended to validate these results and guide clinical practice.