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. 2025 Feb;14(1):283-296.
doi: 10.1007/s40122-024-00683-6. Epub 2024 Dec 3.

Preoperative Analgesia Efficacy of Liposomal Bupivacaine Following Pericapsular Nerve Group (PENG) Block in Patients with Hip Fracture: A Randomized Controlled Observer-Blinded Study

Haobin Peng  1 , Jiajun Wen  1 , Manli Chen  1 , Zhengyuan Xia  2 , Ying Jiang  1 , Kaiqi Xie  1 , Weitao Huang  3 , Bangsheng Cui  3 , Peixing Li  3 , Yiwen Zhang  4 , Xianping Wu  5
Affiliations

Preoperative Analgesia Efficacy of Liposomal Bupivacaine Following Pericapsular Nerve Group (PENG) Block in Patients with Hip Fracture: A Randomized Controlled Observer-Blinded Study

Haobin Peng et al. Pain Ther. 2025 Feb.

Abstract

Introduction: Single-injection pericapsular nerve group (PENG) block with ropivacaine provides clear analgesic effects in preoperative pain management for hip fractures. However, it suffers from insufficient duration, failing to meet the needs of most patients. This single-center, randomized controlled, observer-blinded trial utilizes a novel combination of liposomal bupivacaine (LB) single-injection PENG block to examine its efficacy, duration, and safety in preoperative analgesia for hip fractures, aiming to develop a new preoperative analgesic protocol.

Methods: Sixty-six patients with hip fractures received ultrasound-guided single-injection PENG block with LB or ropivacaine after admission. The primary outcome was the static and dynamic pain scores measured at 48 h post-block. Pain scores at 12, 24, 36, 60, and 72 h post-block, rescue analgesia rate, time to first opioid, additional morphine consumption, and adverse events were assessed as the secondary outcomes.

Results: LB versus ropivacaine group at 48 h post-block, with a median interquartile range (IQR) of 2 (1.0-2.0) versus 3 (2.0-3.0) at static pain score and 2 (1.75-3.0) versus 4 (4.0-5.0) at dynamic pain score. LB group had lower dynamic and static pain scores at other observation points except for the static pain score at 72 h, lower pain intensity [sum of pain intensity difference (SPID)0-24, SPID0-48 and SPID0-72], longer time to first opioid, lower additional morphine consumption, and lower incidence of nausea and vomiting. No significant inter-group differences were detected in other secondary outcomes.

Conclusions: For preoperative analgesia of hip fractures, LB single-injection PENG block had a similar analgesic intensity and safety as ropivacaine but provided a longer duration of analgesia, reaching 48 h and even extending beyond 60 h, which reduced opioid consumption and extended time to the first opioid.

Trial registration: The protocol was registered in www.chictr.org.cn under the identifier ChiCTR2300072939.

Keywords: Hip fracture; Liposomal bupivacaine; Pericapsular nerve group block; Preoperative analgesia.

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Conflict of interest statement

Declarations. Conflict of Interest: Haobin Peng, Jiajun Wen, Manli Chen, Zhengyuan Xia, Ying Jiang, Kaiqi Xie, Weitao Huang, Bangsheng Cui, Peixing Li, Yiwen Zhang and Xianping Wu have no conflict of interest to declare. Ethical Approval: This trial adheres to the Declaration of Helsinki principles. The Medical Ethics Committee of Shunde Hospital of Guangzhou University of Traditional Chinese Medicine in China approved this study (approval number: KY-2023035), and written informed consent was obtained from all participants. The study was registered with the Clinical Trial Center in China (URL: http://www.chictr.org.cn/showproj.html?proj=199250 ; identification number: ChiCTR2300072939; date of registration: June 28, 2023).

Figures

Fig. 1
Fig. 1
CONSORT diagram of patient enrolment. BMI body mass index
Fig. 2
Fig. 2
The static and dynamic pain scores (VAS) at 48 h after PENG block (see text). Values are median (horizontal bars), IQR (box), and range (whiskers). *statistical significance (p < 0.001); + mean value; PENG pericapsular nerve group block, VAS visual analog scale
Fig. 3
Fig. 3
Mean SPID scores in subjects over the first 24, 48, and 72 h following the PENG block (SPID0–24, SPID0–48 and SPID0–72). Statistical analyses were conducted based on the dynamic pain scores at each time point. *p < 0.05 indicates statistical significance. PENG pericapsular nerve group block, SPID sum of pain intensity difference
Fig. 4
Fig. 4
Kaplan–Meier cumulative event rates for time to take first rescue medication due to inadequate analgesia (intent-to-treat population)
See this image and copyright information in PMC

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