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  • Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial

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Original research
Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial
  1. D-Yin Lin1,
  2. Craig Morrison1,
  3. Brigid Brown1,
  4. Alexander Andrew Saies2,
  5. Reshma Pawar1,
  6. Marthinus Vermeulen1,
  7. Stewart Robert Anderson1,
  8. Tsai Sheng Lee1,
  9. Job Doornberg2,
  10. Hidde Maarten Kroon3,4 and
  11. Ruurd Lukas Jaarsma5
  1. 1 Anesthesiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  2. 2 Orthopaedics, Flinders Medical Centre, Bedford Park, South Australia, Australia
  3. 3 Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. 4 Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  5. 5 Orthopaedics and Trauma Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
  1. Correspondence to Dr D-Yin Lin, Anesthesiology, Flinders Medical Centre, Bedford Park, SA 5042, Australia; d-yin.lin{at}sa.gov.au

Abstract

Background The femoral nerve block (FNB) may be used for analgesia in hip fracture surgery. The pericapsular nerve group (PENG) block is a novel regional technique and may provide better pain reduction while preserving motor function, but these blocks have not been directly compared.

Methods In a single-center double-blinded randomized comparative trial, patients presenting for hip fracture surgery received analgesia with either FNB or PENG block. The primary outcome measure was pain scores (Numeric Rating Scale (NRS) 0 to 10). Secondary outcomes were postoperative quadriceps strength, opiate use, complications, length of hospital stay, and patient-reported outcomes.

Results Sixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperatively in recovery (day 0), the PENG group experienced less pain compared with the FNB group. (In the PENG group, 63% experienced no pain, 27% mild pain, and 10% moderate to severe pain. In comparison, 30% of the FNB group reported no pain, 27% mild pain, and 36% moderate to severe pain; p=0.04). This was assessed using an 11-point Likert NRS. Quadriceps strength was better preserved in the PENG group in the recovery unit (assessed using Oxford muscle strength grading, 60% intact in the PENG group vs none intact in the FNB group; p<0.001) and on day 1 (90% intact vs 50%, respectively; p=0.004). There was no difference in other outcomes.

Conclusions Patients receiving a PENG block for intraoperative and postoperative analgesia during hip fracture surgery experience less postoperative pain in the recovery room with no difference detected by postoperative day 1. Quadriceps strength was better preserved with the PENG block. Despite the short-term analgesic benefit and improved quadriceps strength, there were no differences detected in the quality of recovery.

  • nerve block
  • lower extremity
  • pain
  • postoperative
  • analgesia
  • acute pain

Data availability statement

Data are available upon reasonable request. Please contact the corresponding author (Dr D-Yin Lin: d-yin.lin@sa.gov.au).

https://doi.org/10.1136/rapm-2020-102315

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    Data availability statement

    Data are available upon reasonable request. Please contact the corresponding author (Dr D-Yin Lin: d-yin.lin@sa.gov.au).

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    Footnotes

    • Twitter @hiddekroon

    • CM and BB contributed equally.

    • Correction notice This article has been corrected since it published Online First. The author affiliations have been updated.

    • Contributors D-YL: This author conceived, designed, submitted to Ethics and Governance, and realized the study protocol. This author also formulated and completed the database, prepared the drafts, analyzed and prepared the data, and approved and submitted the final manuscript. CM: This author conceived, assisted with designing, writing and submitting the protocol to Ethics and Governance, realized the study, acquired the data, and approved the final manuscript. BB: This author conceived, assisted with designing, writing and submitting the protocol to Ethics and Governance, realized the study, acquired the data, completed the database, and approved the final manuscript. AS: This author reported appropriate patients to the study team for inclusion, conducted post-operative assessments in a blinded fashion, and approved the final manuscript. RP: This author assisted with protocol implementation, and approved the final manuscript. MV: This author assisted with protocol implementation, and approved the final manuscript. SRA: This author assisted with protocol implementation, and approved the final manuscript. TSL: This author assisted with protocol implementation, and approved the final manuscript. JD: This author conceived, assisted with designing, writing and submitting the protocol to Ethics and Governance, realized the study, and approved the final manuscript. HK: This author conceived, assisted with designing, writing and submitting the protocol to Ethics and Governance, analyzed and prepared the data, critically revise the drafts, and approved the final manuscript. RJ: This author conceived, assisted with designing, writing and submitting the protocol to Ethics and Governance, realized the study, lended departmental support, revised the drafts, and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.