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.