Comparison Of Bupivacaine Alone V/S Bupivacaine With Dexamethasone In USG Guided PENG Block For Postoperative Analgesia In Fracture Neck Of Femur Surgeries: A Prospective Randomized Double Blinded Interventional Study At SMS Hospital, Jaipur, Rajasth

Background: Femur fractures are severely painful, especially fractures of the proximal femur, which limit mobility at the hip joint making it more difficult for the patient to sit up. Pericapsular nerve group (PENG) block is an effective means of providing analgesia during transit and positioning for spinal anesthesia which also persists postoperatively. Dexamethasone, a glucocorticoid, when used as an adjuvant to local anesthetics has been found to have prolonged postoperative analgesia and a favorable side effect profile. This study was conducted to evaluate the newly described PENG block with local anesthetics and compare the PENG Block with local anesthetics along with the addition of Dexamethasone as an adjunct to strive for prolonged pain management in such patients. Subjects & Methods: The study was performed on 60 individuals undergoing surgery for fracture neck of femur. Before Spinal Anesthesia, 30 patients received Ultrasonography (USG) guided PENG block with 20 ml of 0.25% Bupivacaine + 1 ml Normal saline and 30 patients received USG guided PENG block with 20 ml of 0.25% Bupivacaine + 1 ml (4 mg) Dexamethasone. VAS score is used to assess pain during positioning, and in the postoperative period for duration of analgesia and requirement of rescue analgesics. Results: Dexamethasone significantly prolonged duration of analgesia of bupivacaine lasting upto 8-12 hours in comparison to control group using bupivacaine alone. The increase in duration of analgesia was more when Group B (663.50±43.89 min) was compared to Group A  (466.83±14.53 min). It significantly lowered the mean opioid (tramadol) consumption for first 24 h in Group B (161.67±21.51) than in Group A (253.33±18.26). Conclusions: This study shows that PENG block provides postoperative analgesia and Dexamethasone as an adjunct significantly prolongs the duration of analgesia and reduces the need for rescue analgesia.