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.