Pericapsular nerve group block with phenol for non-operative hip fracture management in patients living with frailty: a prospective multicentre cohort study.

Abstract

The incidence of hip fractures is rising with the ageing population. For patients living with severe frailty and limited life expectancy, non-operative management is increasingly considered after shared decision-making. Given the limited availability of long-term analgesic options, alternative techniques are needed. Chemical neurolysis via the pericapsular nerve group block approach can selectively target sensory innervation of the hip. A prospective multicentre cohort study was conducted at seven Dutch hospitals. Patients who chose non-operative management for a hip fracture and met the indication for neurolysis were enrolled. Patient-reported outcomes were assessed at 24 h, 1 week, 30 days and 3 months and included: quality of life; pain; analgesic use; mobility; complications; and mortality. We included 103 patients (mean (SD) age 87 (6.4) y); 51% were nursing home residents and 76% had cognitive impairment. The pericapsular nerve group block was performed under ultrasound guidance, with second needle placement in 14/103 (14%) patients. Mean (SD) injected volume of phenol 6% was 10 (3.1) ml. At 1 week, 34/36 (94%) patients reported acceptable pain at rest and 47/53 (89%) reported no or acceptable pain when washing and dressing. A bed-chair transfer was possible in 24/53 (45%) patients at 1 week. No procedure-related adverse events were reported. Mortality rate was 72/91 (79%) after 3 months, with a 30-day mortality of 56/91 (62%) and median (IQR [range]) survival of 9 (6-24 [0-85]) days. The pericapsular nerve group block with phenol 6% is an effective, minimally invasive procedure for pain management in addition to opioid-based pain relief in patients living with frailty, when surgery is not chosen. Procedure standardisation may improve clinical outcomes.