Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial.

Abstract

INTRODUCTION The fascia iliaca block (FIB) is currently recommended as a component of multimodal acute pain management for patients with hip fracture. The pericapsular nerve group (PENG) block is a newer technique that may provide superior analgesia. We therefore designed this study in an academic emergency department to compare the acute analgesic effect of these two approaches in patients with a hip fracture. METHODS Adult patients with an acute hip fracture who reported at least moderate pain were eligible for inclusion. Patients were allocated randomly to receive either a PENG block with 20 ml 0.375% levobupivacaine plus 4 mg dexamethasone or infra-inguinal FIB with 30 ml 0.25% levobupivacaine plus 4 mg dexamethasone. Primary outcome was the percentage of summed pain intensity difference (%SPID) calculated from visual analogue pain scores measured during the first hour post-block. Secondary outcomes included: number of patients reaching 33% and 50% SPID; dose of rescue opioid administered in morphine milligram equivalents; and incidence of adverse events. RESULTS In total, 92 patients were screened for eligibility and 64 were enrolled (32 in each group). Patients allocated to the PENG block group showed a greater %SPID when compared with those allocated to the FIB group (62.7% (95%CI 52.9-72.4%) vs. 38.0% (95%CI 30.7-45.4%), respectively; difference: -24.7% (95%CI -36.6 to -12.7%), p < 0.001). In the PENG group, 24/32 patients achieved 50% SPID compared with 7/32 in the FIB group (p < 0.001). Similarly, in the PENG group, 28/32 patients achieved 33% SPID compared with 19/32 in the FIB group (p = 0.022). There was no significant difference in the rescue opioid dose administered or in the incidence of adverse events. DISCUSSION The PENG block provides superior analgesia for the first hour after intervention when compared with the infra-inguinal FIB and represents a promising modality for acute pain management in emergency departments.