PENG Block With Dexmedetomidine in Older Adults

Summary

Pain after hip surgery is a common problem in older adults and may delay early mobilization, increase the need for opioid pain medications, and contribute to complications such as delirium, nausea, or prolonged hospital stay. Regional anesthesia techniques are increasingly used to improve pain control while reducing the use of systemic opioids. The pericapsular nerve group (PENG) block is a modern ultrasound-guided regional anesthesia technique designed to provide effective pain relief after hip surgery while preserving muscle strength. It allows patients to begin mobilization earlier and may reduce the risk of postoperative complications, which is particularly important in older adults. Ropivacaine is a commonly used local anesthetic for nerve blocks. Dexmedetomidine is a medication that, when added in small doses to local anesthetics, may prolong pain relief and improve the quality of nerve blocks without significantly increasing side effects. However, the benefits and safety of adding dexmedetomidine to the PENG block in older adults have not been sufficiently studied. The aim of this randomized controlled clinical study is to compare the effectiveness and safety of two PENG block techniques in older adults undergoing hip surgery. Participants will be randomly assigned to one of two groups. One group will receive a PENG block with 20 mL of 0.2% ropivacaine. The second group will receive a PENG block with 20 mL of 0.2% ropivacaine combined with 25 micrograms of dexmedetomidine. The study hypothesis is that the addition of dexmedetomidine to ropivacaine in the PENG block will provide longer-lasting and more effective postoperative pain relief compared with ropivacaine alone, without increasing adverse effects. Outcomes assessed in the study will include postoperative pain intensity, need for additional pain medications, time to first mobilization, and the occurrence of side effects such as low blood pressure, slow heart rate, excessive sedation, or delirium. The results of this study may help optimize regional anesthesia techniques for hip surgery in older adults and contribute to safer, more effective postoperative pain management strategies.

Eligibility

Inclusion Criteria:

* Age 65 years or older
* Scheduled for elective or emergency hip surgery (e.g., hip fracture fixation or hip arthroplasty)
* ASA physical status I-III
* Ability to communicate pain intensity using the NRS scale
* Written informed consent obtained from the patient or legal representative
* Planned use of PENG block as part of multimodal perioperative analgesia

Exclusion Criteria:

* Patient refusal or inability to provide informed consent
* Allergy, intolerance, or contraindication to any study medication: ropivacaine, dexmedetomidine
* Pre-existing neurological deficit or neuropathy of the affected limb
* Coagulopathy (INR \>1.5, platelets \<100,000/µL) or current therapeutic anticoagulation that contraindicates regional anesthesia
* Infection at or near the injection site
* Severe hepatic or renal impairment
* History of chronic opioid use (daily opioids \>30 days before surgery)
* Cognitive impairment or delirium precluding reliable pain assessment
* BMI \> 40 kg/m² (if you want to exclude for technical difficulty)
* Patients receiving another regional nerve block for hip surgery
* Pregnancy or breastfeeding
* Participation in another interventional clinical trial within 30 days

Conditions3

Interventions2

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