Pericapsular Nerve Group Block versus Femoral Block for Positioning During Spinal Anesthesia for Hip Fracture Surgeries.

Background: Pericapsular nerve group (PENG) block is a novel approach for dynamic pain relief in hip fractures. Studies on the effectiveness of PENG block for positioning for spinal anesthesia are very few in the Indian population. This study aimed to identify the superior efficacy of PENG block over femoral block for positioning during spinal anesthesia for hip surgeries. This study will help use the PENG block as a better approach to currently used blocks without sparing any articular branches of the nerves to the hip joint.

Materials and methods: Seventy-four patients who were scheduled for hip surgeries for femur fracture were assigned into femoral and PENG groups who received the block before spinal anesthesia. Both groups received 20 mL of 0.25% bupivacaine injected around the femoral nerve. The primary outcome was measured using hemodynamic parameters, visual analog scale (VAS) score, and duration of postoperative analgesia. Secondary outcomes were measured with postoperative analgesic use.

Results: Static and dynamic VAS were significantly different between both groups. Patients from the femoral group showed a significant reduction in static (P = 0.001) and dynamic VAS (P = 0.006) when compared to the PENG group. Static pain and dynamic pain on passive motion after the block had significantly reduced in patients who received femoral block as compared to those who received PENG block. A highly significant difference was seen at 5, 10, and 15 min after the block. While positioning, patients from both groups sat comfortably for spinal anesthesia.

Conclusions: PENG block is a novel alternative technique for regional anesthesia for the hip. We conclude that both PENG and femoral block provide adequate analgesia for positioning for spinal anesthesia.