STUDY OBJECTIVE: We evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures.
METHODS: This prospective, randomized, double-blinded, controlled trial was conducted at a tertiary care academic ED. Adult patients (= 18 years) with traumatic hip fractures and Numerical Rating Scale (NRS) pain scores > 4 were randomized to ultrasound-guided PENG block with bupivacaine or sham procedure. Both groups received standard intravenous analgesia. The primary outcome was the difference in NRS scores over 3 h. Secondary outcomes included total rescue analgesia (morphine equivalents) and adverse events.
RESULTS: Of 167 screened, 80 patients were enrolled (40 per group). Pain scores were significantly lower in the PENG block group at 30 min (mean difference [MD] -3.2; 95% confidence interval [CI]-4.2 to -2.2), 60 min (MD -3.1; 95% CI -4.1 to -2.1), and 120 min (MD -2.0; 95% CI -2.6, -1.4), compared with sham. Total rescue analgesia was significantly lower in the PENG block group (MD -4.6 mg morphine equivalents; 95% CI -6.2 to -3.1). No significant adverse events were reported, such as hematoma, quadriceps weakness, signs of local anesthetic systemic toxicity (LAST), or significant opioid-related adverse events.
CONCLUSION: In adult ED patients with hip fractures, ultrasound-guided PENG block significantly reduced pain scores and opioid requirements compared with sham, with no significant adverse events reported. PENG block may be an effective, opioid-sparing analgesic strategy for acute hip fractures in the ED.
TRIAL REGISTRATION: Clinical Trial Registry-India: CTRI/2023/08/056595.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
No adjustment in the primary outcomes: demographic data, pre-procedural VAS, and fracture type.
Physician rater
The pericapsular nerve group (PENG) block is an ultrasound-guided method for blocking the articular branches of the femoral, obturator, and accessory obturator nerves. These nerves provide sensory innervation to the anterior hip capsule, which would be useful for patients with hip fracture. This study was conducted by an emergency medicine physician and was shown to be effective in elderly patients with hip fracture. This study demonstrates that ultrasound has enabled physicians other than anesthesiologists to perform regional anesthesia.
Physician rater
This prospective, randomized, double-blinded, controlled trial evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures. Adult patients (>= 18 years) with traumatic hip fractures and Numerical Rating Scale (NRS) pain scores > 4 were randomized to ultrasound-guided PENG block with bupivacaine or sham procedure. Both groups received standard intravenous analgesia. The primary outcome was the difference in NRS scores over 3 hours. Eighty patients were enrolled (40 per group). Pain scores were significantly lower in the PENG block group at 30, 60, and 120 minutes compared with sham. Total rescue analgesia was significantly lower in the PENG block group. No significant adverse events were reported. In adult ED patients with hip fractures, PENG block may be an effective opioid-sparing analgesic strategy for acute hip fractures in the ED.
Physician rater
This double-blind RCT evaluated the PENG block with bupivacaine versus sham procedure for adults with traumatic hip fracture and a pain score > 4. The study included 80 patients and found pain scores were lower in the PENG group at 30 minutes (MD -3.2; 95% CI -4.2 to -2.2), 60 min (MD -3.1; 95% CI -4.1 to -2.1), and 120 min (MD -2.0; 95% CI -2.6, -1.4). Rescue analgesia was lower and there were no significant adverse events. Importantly, a single investigator who underwent a structured training protocol performed all nerve blocks, which limits generalizability. The study was also at a single center and the follow-up period was short. This study further supports using PENG block despite these limitations.
Physician rater
This study provides crucial evidence for a novel pain management technique in hip fracture patients. The ultrasound-guided PENG block demonstrates significant potential for reducing pain and opioid requirements, which is particularly valuable in pediatric trauma care. The motor-sparing nature of the block and its minimal complications make it a promising approach for emergency pain management. However, further research with pediatric-specific populations is needed to fully validate these findings.
, McMaster University