OBJECTIVES: To compare the effects of preoperative pericapsular nerve group (PENG) block versus femoral nerve block (FNB) on pain in patients with hip fractures.
METHODS: Sixty eligible patients were randomized (1:1) to receive a PENG block or FNB. The primary endpoint was postblock pain assessed through the visual analog scale (VAS). Secondary endpoints included time to optimal ultrasound imaging, procedure duration, time to first rescue analgesic, 24-hour rescue analgesic consumption, postoperative recovery quality, vital signs, and adverse events.
RESULTS: At 30 minutes postblock, both resting VAS scores (0.0 [0.0, 1.2] vs. 1.1 [0.6, 1.8], P =0.020) and passive movement VAS scores (2.9 [1.7, 3.6] vs. 3.4 [2.7, 4.7], P =0.027) were significantly lower in the PENG group compared with the FNB group. At 12 hours postblock, resting VAS (3.0 [2.1, 4.0] vs. 2.3 [1.7, 2.6], P =0.006) and passive movement VAS (6.8 [5.1, 7.3] vs. 4.9 [4.1, 5.8], P =0.002) were higher in the PENG group. The PENG group achieved optimal ultrasound imaging faster, had an earlier time to first rescue analgesic, and required a greater total dose of rescue analgesics within 24 hours (all P <0.001). Procedure duration, vital signs, and recovery quality did not differ significantly.
DISCUSSION: PENG blocks outperform FNB in imaging speed and early pain control but yield a shorter block duration, thereby increasing 24-hour rescue analgesic demands.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Useful in that this article focuses on the pre-operative period and doesn't include the operation or the post-op period. More and more hospitals are trying to provide optimal pre-op pain relief. However, the results are a bit underwhelming and perhaps expected, in that there is no clinically significant difference between the 2 blocks. Interestingly, the pain scores at 24 hours were lower than the initial pain scores, despite the block likely wearing off.
Physician rater
This article reminds us that easy is not always better. While it was easier to obtain ultrasound images for the pericapsular nerve block, the femoral nerve block provided a longer duration of analgesia, indicating that it is the better choice for patients with hip fractures.
, McMaster University