Pericapsular Nerve Group Block for Analgesia of Positioning pain during Spinal Anesthesia in Hip Fracture Patients, a Randomized controlled Study

Proximal femur fractures are one of the commonest fractures especially in the elderly population. Early surgical fixation is the best analgesic for associated pain[1]. Spinal anesthesia has been favored by many anesthesiologists due to the simplicity of the technique, the better analgesic profile, and the lower incidence of complications like delirium and thromboembolic events[2–4]. However, severe pain, encountered during positioning for spinal anesthesia, can complicate the technique and worsen the patient experience. Different regional blocks were employed to facilitate patient positioning for spinal anesthesia including femoral nerve block (FNB), fascia iliaca compartment block (FICB), and lateral cutaneous nerve block (LCNB)[5–8].
Pericapsular nerve group (PENG) block is a recently regional technique based on blocking the articular branches to the hip joint with a single injection and is utilized for perioperative analgesia in hip surgery[9]. In our study, the PENG block will be conducted before patient transfer to the operating theater for spinal anesthesia. The primary outcome was the pain profile during positioning for the neuroaxial block. Secondary outcomes included the best angle obtained during patient positioning, time to CSF flow, patient experience (pain during positioning and sitting angle), and perioperative complications including quadratus muscle weakness, nausea, vomiting, shivering, and delirium.

股骨近端骨折（Proximal femur fractures）是最常见的骨折类型之一，尤其好发于老年人群。早期手术固定是缓解此类伴随疼痛的最优镇痛方案[1]。脊髓麻醉（Spinal Anesthesia）因操作简便、镇痛谱优良，且谵妄、血栓栓塞事件等并发症发生率更低，受到众多麻醉医师的青睐[2–4]。但在为患者摆放脊髓麻醉体位时引发的剧烈疼痛，可能会增加操作难度，同时降低患者的就医体验。既往已有多种区域阻滞技术被用于辅助脊髓麻醉的体位摆放，包括股神经阻滞（Femoral Nerve Block, FNB）、髂筋膜间隙阻滞（Fascia Iliaca Compartment Block, FICB）及股外侧皮神经阻滞（Lateral Cutaneous Nerve Block, LCNB）[5–8]。
囊周神经群（Pericapsular Nerve Group, PENG）阻滞是一项新兴的区域阻滞技术，通过单次注射阻断支配髋关节的关节支，用于髋关节手术的围术期镇痛[9]。本研究中，我们将在患者转运至手术室行脊髓麻醉前实施PENG阻滞。本研究的主要结局指标为神经轴阻滞（Neuroaxial Block）麻醉体位摆放过程中的疼痛状况；次要结局指标包括体位摆放时可获得的最佳角度、脑脊液（Cerebrospinal Fluid, CSF）流出时间、患者体验（体位摆放时的疼痛程度与坐位角度），以及围术期并发症，具体包括股方肌无力、恶心、呕吐、寒战与谵妄。