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. 2025 Jul 29.
doi: 10.1111/anae.16695. Online ahead of print.

Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial

Santi Di Pietro  1   2   3 , Riccardo Maffeis  1 , Eugenio Jannelli  4 , Benedetta Mascia  5 , Flavia Resta  1 , Annalisa De Silvestri  6 , Valeria Musella  6 , Clarissa Elisabeth Centurioni  7 , Elena Regeni  8 , Federico Alberto Grassi  4 , Alessandro Locatelli  5 , Stefano Perlini  1 ; Regional Anaesthesia in Emergency Medicine (RAEM) Research Group
Collaborators, Affiliations

Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial

Santi Di Pietro et al. Anaesthesia. .

Abstract

Introduction: The fascia iliaca block (FIB) is currently recommended as a component of multimodal acute pain management for patients with hip fracture. The pericapsular nerve group (PENG) block is a newer technique that may provide superior analgesia. We therefore designed this study in an academic emergency department to compare the acute analgesic effect of these two approaches in patients with a hip fracture.

Methods: Adult patients with an acute hip fracture who reported at least moderate pain were eligible for inclusion. Patients were allocated randomly to receive either a PENG block with 20 ml 0.375% levobupivacaine plus 4 mg dexamethasone or infra-inguinal FIB with 30 ml 0.25% levobupivacaine plus 4 mg dexamethasone. Primary outcome was the percentage of summed pain intensity difference (%SPID) calculated from visual analogue pain scores measured during the first hour post-block. Secondary outcomes included: number of patients reaching 33% and 50% SPID; dose of rescue opioid administered in morphine milligram equivalents; and incidence of adverse events.

Results: In total, 92 patients were screened for eligibility and 64 were enrolled (32 in each group). Patients allocated to the PENG block group showed a greater %SPID when compared with those allocated to the FIB group (62.7% (95%CI 52.9-72.4%) vs. 38.0% (95%CI 30.7-45.4%), respectively; difference: -24.7% (95%CI -36.6 to -12.7%), p < 0.001). In the PENG group, 24/32 patients achieved 50% SPID compared with 7/32 in the FIB group (p < 0.001). Similarly, in the PENG group, 28/32 patients achieved 33% SPID compared with 19/32 in the FIB group (p = 0.022). There was no significant difference in the rescue opioid dose administered or in the incidence of adverse events.

Discussion: The PENG block provides superior analgesia for the first hour after intervention when compared with the infra-inguinal FIB and represents a promising modality for acute pain management in emergency departments.

Keywords: acute pain; analgesia; fascia iliaca block; pericapsular nerve group block; regional anaesthesia.

Plain language summary

When people break their hip, they usually feel a lot of pain. Doctors use special kinds of pain relief to help them feel better. This includes nerve blocks to make the hip feel numb. One type is called the fascia iliaca block, and another newer one is the PENG block. This study was done in a hospital emergency department to see which block worked better at reducing pain quickly for people with a hip fracture. Doctors randomly chose which block each patient would get. They picked patients who had a broken hip and were in moderate or worse pain. One group got the PENG block, using 20 ml of a numbing medicine with a small amount of another helpful drug. The other group got the fascia iliaca block, using a little more of a slightly weaker numbing medicine and the same extra drug. The main goal was to see how much the pain went down after the block. Other things they checked were: how many patients had at least a third or half less pain; how much extra pain medicine (like morphine) was needed; and if anyone had bad side effects. Out of 92 patients checked, 64 joined the study (32 in each group). Patients who got the PENG block had a bigger drop in pain than those who got the fascia iliaca block. In the PENG block group, 28 out of 32 patients felt at least a third less pain, compared to 19 out of 32 in the other group. Both groups needed about the same amount of extra pain medicine. The PENG block helped reduce pain better in the first hour after treatment than the fascia iliaca block. It looks like a good option for helping patients with hip fractures feel better in the emergency department.

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