Background and Aims Preoperative rehabilitation in femoral-neck fracture patients has been shown to improve postoperative outcomes but it can be challenging due to intolerable pain. The pericapsular nerve group (PENG) block has been utilized for postoperative pain control for femoral-neck fracture repair with motor-sparing features. This study seeks to assess the efficacy of PENG block in preoperative rehabilitation for femoral-neck fracture patients.
Methods Ten patients with Garden classification 3-4 femoral-neck fractures scheduled for total hip arthroplasty, were prospectively enrolled from April-July 2022 at Kameda Medical Center, Japan (PENG group). These patients received PENG block with 20 ml of 0.375% ropivacaine before the initial preoperative rehabilitation. The rehabilitation program included nine mobility levels of bed-sitting, edge-sitting, standing, wheelchair-transfer, marching, walking with two or one staff, and walking with or without a device. Data from twenty-six patients with the same eligibility who received the same rehabilitation program with standard pain management from April 2021-March 2022 were collected as a control group. The primary outcome was the cumulative outcome of the rehabilitation program. The secondary outcomes included the numerical rating scale (NRS) score and home-discharge rate.
Results One patient in the PENG group could not perform rehabilitation due to high blood pressure. The primary outcome achievement was significantly greater in the PENG group (44.4% vs. 8.5%; odds ratio: 8.5, 95% CI: 4.3-17.0; p<0.0001). The PENG group also had a significantly lower NRS score and a higher home-discharge rate. No adverse events related to PENG block were observed.
Conclusions PENG block may facilitate preoperative rehabilitation in femoral-neck fracture patients.
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