PENG Block in Comparison With FICB for Hip Reconstruction in Children

The main question it aims to answer is: Is the PENG block an effective and safe method of pain relief for hip surgery in children? Participants will be randomized into two equal groups. The group who underwent US - guided PENG block, and the group who underwent US - guided FICB . In both groups we used 0.5% ropivacaine. The same postoperative analgesia regimen was applied by intravenous acetaminophen , oral ibuprofen . In case of ineffectiveness of the prescribed drugs, promedol was used intramuscularly. The postoperative consumption of promedol, time to first rescue analgesia, numerical pain score (NRS) (for children from 7 years old), FLACC score, measurements of A.N.I. monitor MDMS and the side effects will be recorded

• Pericapcelar group nerve block (Procedure): In the supine position, a high-frequency linear sensor is placed in the anterior superior iliac spine and then aligned with the ramus of the pubis by rotating the probe counterclockwise approximately 45 degrees. The iliopsoas muscle and tendon, femoral artery, and pectineus muscle were observed in this view.The iliopsoas muscle and its tendon are visualized, as well as the vascular and nerve bundle: femoral artery, vein, and nerve. The needle is inserted laterally to medially in a planar approach to place the tip in the musculofascial plane between the psoas tendon anteriorly and the ramus pubis posteriorly. After negative aspiration, local anesthetic will be gradually injected aspirating every 3 mL.
• Fascia iliaca compartment block (Procedure): In the supine position, a high-frequency linear sensor is placed in the inguinal fold. Scan starting lateral to the femoral artery and the nerve in the inguinal crease to identify the sartorius muscle, tracing the muscle to its origin to the anterior superior iliac spine. A shadow of the iliac crest bone and iliacus muscle will be visible, with the end point of injection being deep in the fascia iliaca and above the iliacus muscle at the lateral aspect of the iliacus muscle. After negative aspiration, local anesthetic will be gradually injected under the fascial plane, aspirating every 3 mL.

Primary outcomes

• Opioids consumption [24 hours]: Total dosage of opioids in postoperative period

Secondary outcomes

• Time to rescue analgesia [24 hours]: Time to first accepted of opioid analgesia
• Pain level [2, 6, 12, 24 hours after completing the block]: Assessing level of pain. Using pain scales. Face, Legs, Activity, Cry, Consolability (FLACC) scale for children from 3 to 7 years old. The scale is scored in a range of 0-10 with 0 representing no pain, and 10 representing maximal pain. The numeric rating scale (NRS) is a verbal or written determination of a pain level on a scale from 0 to 10, in which 0 represents no pain and 10 represents excruciating pain. Analgesia-nociception index (ANI). Using "ANI Monitor".
• Intraoperative level of analgesia [Intraoperatively]: Analgesia-nociception index (ANI). Using "ANI Monitor".

Sex: All, ages: 3 Years to 17 Years

Inclusion Criteria:

* reconstructive surgery on the hip joint
* children with cerebral palsy/ spina bifida/organic brain injury
* age 3 - 18 years.

Exclusion Criteria:

* contraindications to the use of local anesthetics
* contraindications to performing an invasive procedure
* ASA > 3