Authors: Liao H et al.
Journal of Clinical Anesthesia 2025
Summary
This prospective, observer-blinded randomized controlled study compared the pericapsular nerve group (PENG) block with the ultrasound-guided supra-inguinal fascia iliaca compartment block (sFICB) for preoperative analgesia in elderly patients undergoing hip fracture surgery. Adequate analgesia before positioning for spinal anesthesia is critical in this population, as severe pain during position changes can precipitate hemodynamic instability and perioperative complications in frail patients with cardiovascular comorbidities.
Sixty-four patients aged 65 years or older with hip fractures were randomized to receive either a PENG block or sFICB prior to intrathecal anesthesia. The primary outcomes included block success rate, pain scores, and procedural timing. Secondary outcomes included vital signs, postoperative analgesia, morphine consumption, and adverse events.
The PENG block demonstrated a significantly higher success rate than sFICB (90.6% vs 68.8%). Patients in the PENG group experienced significantly lower numeric rating scale pain scores prior to spinal anesthesia and required less time to perform both the nerve block and spinal anesthesia. These findings suggest that PENG block facilitates faster and more comfortable positioning for neuraxial anesthesia.
Importantly, there were no significant differences between the two groups in postoperative pain relief, opioid consumption within the first two postoperative days, vital signs, or incidence of adverse reactions. This indicates that the advantages of PENG block are primarily seen in the preoperative period, without sacrificing postoperative analgesic efficacy or safety.
The authors conclude that PENG block offers superior preoperative analgesia and a higher procedural success rate compared with supra-inguinal fascia iliaca block in elderly hip fracture patients. Its use may improve patient comfort, reduce procedural time, and potentially decrease perioperative stress during spinal anesthesia placement in this high-risk population.
Key Points
PENG block achieved a higher success rate than supra-inguinal fascia iliaca block
Preoperative pain scores were significantly lower with PENG block
Time required for nerve block and spinal anesthesia was shorter with PENG
Postoperative pain control and opioid consumption were similar between groups
PENG block may be preferable for pre-spinal positioning in frail elderly patients
Thank you to the Journal of Clinical Anesthesia for allowing us to summarize this study and highlight evolving best practices in regional anesthesia for hip fracture surgery.