Efficacy of Ultrasound-Guided PENG Block for Acute Pain Relief in Adult Hip Fracture Patients: A Double-Blind Randomized Trial

Abstract

Study Objective: We evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures. Methods: This prospective, randomized, double-blinded, controlled trial was conducted at a tertiary care academic ED. Adult patients (≥ 18 years) with traumatic hip fractures and Numerical Rating Scale (NRS) pain scores > 4 were randomized to ultrasound-guided PENG block with bupivacaine or sham procedure. Both groups received standard intravenous analgesia. The primary outcome was the difference in NRS scores over 3 h. Secondary outcomes included total rescue analgesia (morphine equivalents) and adverse events. Results: Of 167 screened, 80 patients were enrolled (40 per group). Pain scores were significantly lower in the PENG block group at 30 min (mean difference [MD] −3.2; 95% confidence interval [CI]-4.2 to −2.2), 60 min (MD −3.1; 95% CI −4.1 to −2.1), and 120 min (MD −2.0; 95% CI −2.6, −1.4), compared with sham. Total rescue analgesia was significantly lower in the PENG block group (MD −4.6 mg morphine equivalents; 95% CI −6.2 to −3.1). No significant adverse events were reported, such as hematoma, quadriceps weakness, signs of local anesthetic systemic toxicity (LAST), or significant opioid-related adverse events. Conclusion: In adult ED patients with hip fractures, ultrasound-guided PENG block significantly reduced pain scores and opioid requirements compared with sham, with no significant adverse events reported. PENG block may be an effective, opioid-sparing analgesic strategy for acute hip fractures in the ED. Trial Registration: Clinical Trial Registry-India: CTRI/2023/08/056595.