Fascia iliaca compartment block and pericapsular nerve group block effect on opioid consumption in hip fracture patients

Abstract

Background: Effective pain control and reduced opioid consumption improve hip fracture outcomes. Fascia iliaca compartment blocks (FICB) effectively and safely manage acute hip fracture pain while reducing opioid consumption. Alternatively, pericapsular nerve group (PENG) blocks may provide similar analgesia while better-preserving motor function by targeting the highly innervated anterior hip capsule and sensory branches of the femoral, obturator, and accessory obturator nerves. Evidence for PENG's effectiveness is limited. The present retrospective study compared pain and MME in hip fracture patients receiving FICB (n = 1596) or PENG (n = 254), vs. a no-block (NB; n = 287) reference group. Methods: Patients presenting to a single institution from December 2011 through August 2021 with femoral neck or intertrochanteric fractures were included and analyzed retrospectively. Patients were excluded for age<65 years or high-energy trauma. Primary outcomes were morphine milligram equivalents (MME) and patient-reported pain preoperatively through postop day (POD) 3. Results: Included patients were >65 years of age, majority female, and had mean Charlson Comorbidity Index = 1.86. FICB and PENG received significantly lower preoperative, POD1, and total MME versus NB (p < 0.05). Pairwise comparisons showed that PENG patients received 55–86 % lower MME compared to FICB at each time point, and significantly lower total MME (84.9 vs. 106.8; p < 0.05). Average pain was lower in FICB than NB on POD1 and across the entire period (p < 0.05), but there were no other significant pain differences (p > 0.05). Conclusions: FICB and PENG for acute hip fracture management resulted in significantly lower opioid consumption during admission without elevated pain. Lower MME in FICB/PENG was most notable pre-operatively and on POD1, leading to lower total MME. Although total MME was lower in PENG versus FICB, this difference was relatively small compared to the larger opioid-reducing effects both blocks had versus NB. PENG appears to manage pain and opioids similarly to FICB while preserving motor function. Level of evidence: Level III Retrospective Cohort Study.