An interventional study of Pericapsular Nerve Group Block and Lumbar Erector Spinae Plane Block in Femur Neck Fracture, Hip Fractures and Postoperative Pain, sponsored by Beni-Suef University. Not yet recruiting at 1 site in Egypt. Open to participants aged 60 Years and older. Per ClinicalTrials.gov, last updated 2026-11-04.
Sponsored by Beni-Suef University · Not applicable, Interventional, and Treatment
The purpose of this clinical trial is to compare two different nerve block techniques-the Pericapsular Nerve Group (PENG) block and the Lumbar Erector Spinae Plane Block (L-ESPB)-for managing pain after hip fracture surgery in elderly patients.
Hip fractures are common in older adults and often cause significant pain. Managing this pain effectively helps patients recover faster and move around sooner after surgery. Traditional pain relief options include nerve blocks and strong pain medications (opioids). However, opioids can cause unwanted side effects like nausea and drowsiness, while some traditional nerve blocks can weaken the leg muscles, making early walking difficult.
Nerve blocks inject a local anesthetic (numbing medication) around specific nerves or within muscle layers to temporarily block pain signals:
Participants in this study will include adults aged 60 and older undergoing hip surgery for a femoral neck fracture under spinal anesthesia. Participants will be randomly assigned (like flipping a coin) to receive either the PENG block or the Lumbar ESPB before their surgery. Both blocks are performed under ultrasound guidance to ensure precise medication placement.
Researchers will compare:
The findings from this study will help doctors determine which nerve block provides better pain relief while preserving leg strength, aiding in safer and faster recovery for elderly patients after hip surgery.
BACKGROUND AND RATIONALE:
Hip fractures in elderly patients are associated with significant morbidity, prolonged hospitalization, and functional decline. Effective perioperative analgesia is crucial for early recovery. While systemic opioids and conventional nerve blocks (such as femoral or fascia iliaca blocks) provide pain relief, they are often limited by quadriceps weakness, opioid-related side effects, and delayed mobilization.
The Pericapsular Nerve Group (PENG) block targets the articular branches of the femoral, obturator, and accessory obturator nerves supplying the anterior hip capsule, offering motor-sparing analgesia. The lumbar erector spinae plane block (L-ESPB) is a paraspinal fascial plane block allowing craniocaudal local anesthetic spread to dorsal and ventral rami. Head-to-head evidence comparing L-ESPB and PENG blocks in patients with femoral neck fractures undergoing hip surgery remains limited.
STUDY PROTOCOL \& INTERVENTIONS:
This prospective, randomized, double-blind, parallel-group clinical trial evaluates elderly patients (age ≥60 years, ASA II-III) undergoing hip surgery (hemiarthroplasty or total hip arthroplasty) under spinal anesthesia.
Participants are randomized in a 1:1 ratio to receive either:
Blocks are performed 20 minutes preoperatively by a dedicated anesthetist not involved in outcome assessment. All patients receive standardized intraoperative spinal anesthesia and postoperative multimodal systemic analgesia (scheduled IV/oral paracetamol with IV pethidine as rescue analgesia). Pain scores at rest and on movement, cumulative 24-hour opioid consumption, quadriceps strength (MRC scale), block-related complications, and length of hospital stay will be evaluated.
212 studies on the registry are indexed under Femoral Neck Fractures; 43 are open to participants now.
This study's planned enrollment of 64 is below the median of 100 across 148 interventional studies indexed under Femoral Neck Fractures.
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Exclusion Criteria:
Patients receive an ultrasound-guided Pericapsular Nerve Group (PENG) block preoperatively using 20-25 mL of 0.25% bupivacaine (50-62.5 mg) deposited in the fascial plane between the iliopsoas tendon and pubic ramus near the iliopubical eminence (IPE). Standard spinal anesthesia and postoperative multimodal systemic analgesia are administered.
Procedure: Pericapsular Nerve Group Block
Patients receive an ultrasound-guided Lumbar Erector Spinae Plane Block (L-ESPB) preoperatively at the L3 or L4 transverse process level using 25-30 mL of 0.25% bupivacaine (62.5-75 mg) deposited deep to the erector spinae muscle. Standard spinal anesthesia and postoperative multimodal systemic analgesia are administered.
Procedure: Lumbar Erector Spinae Plane Block
Ultrasound-guided nerve block performed 20 minutes preoperatively in the supine position. A 22G echogenic needle is directed in-plane lateral-to-medial to target the fascial plane deep to the iliopsoas tendon. Following negative aspiration and hydrodissection (2-3 mL saline), 20-25 mL bupivacaine 0.25% (or 15-20 mL in frail/small patients) is injected in 3-5 mL aliquots.
Also known as: PENG Block
Ultrasound-guided fascial plane block performed 20 minutes preoperatively in the lateral decubitus or sitting position. A 22G echogenic needle is advanced in-plane cranial-to-caudal to contact the L3 or L4 transverse process. Following negative aspiration and hydrodissection confirming muscle lifting, 25-30 mL bupivacaine 0.25% is injected in 3-5 mL aliquots.
Also known as: Lumbar ESPB, L-ESPB
Postoperative Pain Score on Movement at 12 Hours
Pain intensity assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Pain is evaluated during gentle passive leg movement (flexion or rotation) of the operated limb.
Time frame: 12 hours after the end of surgery
Postoperative Pain Scores at Rest and Movement at Specified Time Points
Pain intensity measured using the Numeric Rating Scale (NRS 0-10, where 0 = no pain and 10 = worst imaginable pain) at rest and during gentle passive movement of the operated limb.
Time frame: 30 minutes, 2 hours, 6 hours, 24 hours, and 48 hours after surgery
Cumulative Opioid Consumption in the First 24 Hours
Total dose of intravenous pethidine (meperidine) administered as rescue analgesia in milligrams (mg).
Time frame: First 24 hours postoperatively
Time to First Rescue Analgesic Request
Duration of time measured in hours from the end of surgery until the patient requests the first dose of rescue IV pethidine.
Time frame: Up to 48 hours postoperatively
Quadriceps Motor Function (Knee Extension Strength)
Evaluation of ipsilateral quadriceps muscle strength using the Medical Research Council (MRC) scale, ranging from 0 (no movement) to 5 (normal strength). Motor weakness is defined as an MRC grade ≤ 3/5.
Time frame: At 6, 12, and 24 hours postoperatively
Incidence of Block-Related Complications and Opioid-Related Adverse Events
Percentage of participants experiencing adverse events including postoperative nausea and vomiting (PONV), pruritus, urinary retention, hypotension, bradycardia, signs of local anesthetic systemic toxicity (LAST), hematoma, injection site infection, neurological deficit/nerve injury, or falls.
Time frame: Up to 48 hours postoperatively
Length of Hospital Stay
Duration of time from surgery completion until discharge from the hospital, measured in total days.
Time frame: From date of surgery until hospital discharge (up to approximately 30 days)
Plan to share: Yes — Individual de-identified participant data underlying the published primary and secondary results (including demographic data, baseline characteristics, NRS pain scores, cumulative opioid consumption, quadriceps motor strength scores, and adverse events) will be made available upon reasonable request to qualified academic researchers.
Supporting information: Study protocol, Statistical analysis plan
Time frame: Data will become available starting 6 months following publication of the primary manuscript in a peer-reviewed journal and will remain accessible for up to 3 years.
Access criteria: Data will be shared with researchers whose proposed use has been approved by an independent review committee or the principal investigator to achieve the aims of an approved scientific proposal. Requests should be directed to the Principal Investigator (Dr. Kerollos Moneer Neseem Mikhael) via email. A signed Data Use Agreement (DUA) may be required.
No publications or documents are linked to this record.
Start is estimated for Nov 2026; primary completion for Apr 2027, 5 months later.
Of 68 non-industry interventional studies with no phase under Femoral Neck Fractures, half reached primary completion within 46 months of starting (the median), counting those still running; a quarter within 21 and three quarters within 62. This study's planned 5 months is below that.
Counting every sponsor, half of 74 studies reached it within 47 months; a quarter within 25 and three quarters within 63.
Start moved once since we started tracking on Sep 25, 2026: Oct 2026 → Nov 2026, on Nov 4, 2026.
Earlier changes are on the record history on ClinicalTrials.gov ↗
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is not yet recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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