Authors: Liao H et al.
Journal of Clinical Anesthesia. 2025.
Summary
This prospective, randomized controlled study compared the effectiveness of the pericapsular nerve group (PENG) block with the supra-inguinal fascia iliaca compartment block (sFICB) for preoperative analgesia in elderly patients undergoing surgery for hip fracture. Positioning for neuraxial anesthesia in this population often causes severe pain and can precipitate cardiovascular instability, making effective preoperative analgesia particularly important.
Sixty-four patients aged 65 years or older with hip fractures were enrolled and randomly assigned to receive either an ultrasound-guided PENG block or sFICB before spinal anesthesia. The primary outcomes included block success rate, pain scores during positioning, and procedural efficiency. Secondary outcomes included hemodynamic stability, postoperative pain control, opioid consumption, and adverse events.
The PENG block demonstrated a significantly higher success rate compared with sFICB. Patients receiving the PENG block experienced significantly lower numeric rating scale pain scores during positioning and shorter times to complete both nerve block placement and spinal anesthesia. Despite these advantages, postoperative outcomes—including vital signs, postoperative pain relief, morphine consumption over the first two postoperative days, and adverse events—were similar between groups.
Overall, the findings suggest that PENG block provides superior preoperative analgesia and procedural efficiency compared with sFICB in elderly patients with hip fractures, particularly for facilitating positioning prior to spinal anesthesia. The authors conclude that PENG block may represent a more effective preoperative regional anesthesia strategy in this high-risk population.
Key Points
PENG block had a higher success rate than supra-inguinal fascia iliaca block in elderly hip fracture patients.
Pain scores during positioning for spinal anesthesia were significantly lower with PENG block.
Time required to perform the nerve block and spinal anesthesia was shorter with PENG block.
Postoperative pain control, opioid consumption, and adverse events were similar between groups.
PENG block appears to be a more effective preoperative analgesic technique for facilitating neuraxial anesthesia in hip fracture surgery.
Thank you for allowing us to review and summarize this clinically relevant study from the Journal of Clinical Anesthesia.