Pericapsular Nerve Group Block for Hip Fracture Pain Management: A Narrative Review of Emergency Applications.

Abstract

The pericapsular nerve group (PENG) block is a regional anaesthesia technique for acute pain management that is becoming frequently employed for emergency lower limb fractures, particularly hip injuries. While current evidence has been predominantly derived from postoperative randomized trials and case series, the results of recent clinical reports support the preprocedural utility of the PENG block in emergency settings for rapid analgesia 40-60% pain score reduction and preservation of motor function. This review synthesizes mechanistic insights and clinical outcomes from the literature, comparing the targeted sensory blockade of the hip capsule with the PENG block with that of systemic opioids (which risks inducing respiratory depression) and fascia iliaca block (which can induce motor impairment). Key advantages of PENG blockade include significant opioid-sparing effects (50-70% reduction morphine use) and almost no motor complications. Standardized ultrasound-guided protocols can address challenges related to anatomical variability. Preliminary evidence from case reports suggests that the efficacy of the PENG block to pelvic and femoral shaft fractures, although multicentre trials are needed to establish optimal doses and long-term functional outcomes. This evidence indicates that PENG blockade could serve as a promising emergency intervention, but further protocol refinement is warranted.