Use of Dexamethasone Via Two Different Methods in PENG Block

Hip fractures are morbid conditions, especially in elderly patients, and their treatment is usually surgical. Pericapsular nerve group block targets the hip capsule. The aim of this study is to investigate and compare the perioperative analgesic efficacy of PENG blocks applied investigation of the effect of perinuerally and systemic dexamethasone on pain scores in the first 24 hours of PENG block in patients undergoing hip fracture surgery under spinal anesthesia.

44 ASA II-IV patients between 50-80 years of age who will be operated for femoral neck fractures will be included in the study.

PENG block is routinely used in our clinic to provide postoperative analgesia in hip surgery. Depending on the comorbid conditions of the patients, dexamethasone may be added as an adjuvant agent to improve the quality of the block. We aimed to observe the systemic and perinuerally effects of dexamethasone used in PENG block in patients operated for femoral neck fracture in our clinic.

In this observational and prospective study, patients operated for femoral neck fracture and treated with PENG block will be analyzed in the postoperative period. Pain scores, degree of nausea and vomiting, recovery time of sensory and motor block, and blood glucose levels in the first 24 hours will be recorded in patients who received dexamethasone perinuerally and in patients who received systemic dexamethasone intravenously. In addition, the time to first analgesic requirement, mobilization time and hospital stay of the two groups will also be recorded.

The anesthesiologist performing the block will not participate in the pain monitoring of the patients. Postoperative pain assessment and data collection will be performed by another anesthesiologist blinded to the study. For the quality and standardization of the block, the block will be performed by an experienced anesthesiologist who has performed the block successfully and without complications at least 20 times before.

Inclusion criteria

• 50-85 years old
• Patients who underwent surgery for femoral neck fracture under spinal anesthesia with PENG block
• Patients of either sex with a body mass index (BMI) < 35 kg/m2
• ASA II-IV patients
• Patients signing the informed consent form

Exclusion criteria

• ASA-V patients
• Alcohol, drug addiction
• Patients with a history of opioid drug use for more than four weeks
• Patients with chronic pain disorders (patients on regular analgesics >3 months)
• Patients with a history of local anesthetic or opioid allergy or hypersensitivity
• Patient group in whom regional anesthesia is contraindicated (coagulopathy, INR (international correction ratio) not within normal limits, thrombocytopenia or platelet dysfunction, infection at the injection site)
• Those with severe psychiatric illnesses such as psychosis, dementia, etc. that limit their cooperation with the patient
• Patients who do not give consent/ do not want to participate
• Patients who were evaluated as failed block on dermatomal examination after block application