PENG Block Variants With Dexamethasone and Dexmedetomidine in Older Adults

Summary

This study will compare three different versions of the Pericapsular Nerve Group (PENG) block in adults aged 65 years and older who are undergoing surgery for hip conditions. The PENG block is a regional anesthesia technique that can reduce pain after surgery and decrease the need for strong opioid pain medications. All patients in the study will receive the PENG block with 20 mL of 0.2% ropivacaine, but they will be divided into three groups based on the additional medications used: Group 1: PENG block with ropivacaine plus 4 mg of dexamethasone given intravenously. Group 2: PENG block with ropivacaine plus 25 micrograms of dexmedetomidine given near the nerves and 4 mg of dexamethasone given intravenously. Group 3: PENG block with ropivacaine plus 25 micrograms of dexmedetomidine and 4 mg of dexamethasone given near the nerves. Both dexmedetomidine and dexamethasone are medications that may improve the strength and duration of nerve blocks. The main goal of this study is to determine which combination provides the best pain control after hip surgery, reduces the need for opioid medications, and improves patient comfort and recovery. We also aim to evaluate the safety and side-effects of each technique. We hypothesize that adding both dexmedetomidine and dexamethasone near the nerves will provide the longest and most effective pain relief when compared to intravenous administration alone. This trial may help identify the most effective PENG block formula for older adults undergoing hip surgery and could improve pain management, decrease complications related to opioids, and support faster recovery.

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, dexamethasone, 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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