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

D. Yin Lin, Craig Morrison, Brigid Brown, Alexander Andrew Saies, Reshma Pawar, Marthinus Vermeulen, Stewart Robert Anderson, Tsai Sheng Lee, Job Doornberg, Hidde Maarten Kroon, Ruurd Jaarsma

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)398-403
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume46
Issue number5
Early online date26 Feb 2021
DOIs
Publication statusPublished - 1 May 2021
Externally publishedYes

Keywords

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

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