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

Abstract

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. 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. 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. 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. Clinical Trial Registry-India: CTRI/2023/08/056595.