BACKGROUND: Currently three types of regional nerve blocks are commonly administered to provide analgesia to patients with hip fractures; the Fascia-Iliaca Compartment Block (FICB), Femoral Nerve Block (FNB) and Pericapsular Nerve Group Block (PENG). It is unclear which of these provides the best analgesia and the lowest number of complications.
AIM: This systematic review aims to evaluate the literature concerning the efficacy and safety of pre-operatively placed PENG block compared to FICB and FNB for hip fractures.
METHODS: The PRISMA statement guidelines were used and a systematic search of MEDLINE (via Ovid), Embase, Web of Science and Google Scholar was performed until April 8th, 2024.
RESULTS: Out of 118 identified studies, 17 (14 RCTs, 3 observational) met the inclusion criteria, of which 5 exhibited a low risk of bias. Pain scores were significantly lower with the PENG block compared to FICB/FNB in 12 of 17 studies, while 5 reported no difference. Opioid use was lower in 4 of 11 studies favoring PENG, while the other 7 showed no differences with FICB/FNB. Patient satisfaction was found to be higher in PENG in 5 studies, while 2 other reported no difference. Ease of spinal positioning was better with PENG in 4 studies, with 3 reporting no difference. Adverse events showed no significant differences between blocks. None of the studies found FNB or FICB to be favorable on any of these outcomes.
CONCLUSIONS: PENG block may be a promising technique to provide analgesia to patients with hip fractures. However, there was significant heterogeneity in endpoints used and in outcomes of the various studies that compared PENG with FNB or FICB blocks. Also, only one study was conducted in the emergency department (ED). Larger randomized controlled trials with patient-centred outcomes in the ED-setting are required to definitively establish which nerve block is most effective.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The review is characterised by significant bias, imprecision, and a lack of quantitative analysis that is consistent with meta-analyses. Also, the subgroup analysis was not evaluated according to an adjuvant or other systemic analgesics, and there was an absence of TSA.
Physician rater
The PENG block is a relatively new and valid alternative technique for regional anaesthesia. A better understanding of hip innervation anatomy and the planes on and in which the responsible nerves run and flow opens up new therapeutic options that need to be evaluated and validated. The PENG block belongs to the deep nerve blocks and is therefore subject to the rules of withdrawal of anticoagulants and antiaggregants in spinal and epidural anaesthesia. Refer to the EJA guidelines (2022).
Physician rater
The results are somewhat helpful; however, due to the low- to very low-certainty evidence and the heterogeneity, it is not yet practice- changing. This is especially so because all but one study was outside of the ED. The ease of placement and skill of the average ED practitioner are unknowns.
, McMaster University