Assessing the Efficacy of Pericapsular Nerve Group Block with Ultrasonography in Hip Fracture Patients: Evidence from Emergency Department of a Tertiary Care Hospital

INTRODUCTION: Hip fractures, prevalent in aging populations, are linked to significant morbidity and mortality, with cases projected to rise from 1.66 million in 1990 to 6.26 million by 2050. Effective pain management remains a challenge, particularly in elderly patients with comorbidities, as traditional systemic analgesics like opioids often cause adverse effects. The pericapsular nerve group (PENG) block, introduced in 2018, provides effective pain relief by targeting the articular branches of the femoral, obturator, and accessory obturator nerves without causing motor impairment. This study assesses the efficacy of PENG blocks compared to conventional systemic analgesics for hip fracture pain relief.(1–3) OBJECTIVES: Primary: To evaluate the efficacy of ultrasound-guided PENG block in hip fracture patients in the emergency department versus conventional intravenous analgesics. Secondary: To assess the need for systemic analgesia as rescue analgesia and identify adverse events following the PENG block. MATERIALS AND METHODS: Study Site: Base Hospital, Delhi Cantt. Population: Hip fracture patients presenting to the emergency department. Inclusion Criteria: Conscious patients >18 years with a pain score (NRS) ≥4. Exclusion Criteria: Unstable vitals (SBP <90 mmHg, HR <60/min), coagulopathy, psychiatric conditions, polytrauma, infection at injection site, limb prostheses, allergies to local anesthetics, polyneuropathy, or refusal to consent. DESIGN AND DURATION: Observational-interventional study conducted from January 2024 to January 2025. Procedure: Baseline demographics, medical history, and pain scores were recorded. Patients underwent an ultrasound-guided PENG block (20 mL of 0.25% bupivacaine) performed by a trained physician under aseptic conditions. Pain scores were recorded at baseline, 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h. Outcomes included pain scores (VAS), systemic analgesic use, block efficacy, and complications (neurological or cardiovascular symptoms). RESULTS: Sixty patients (30 PENG group, 30 control group) were analyzed. Pain scores were significantly lower in the PENG group both at rest and during leg elevation. At rest, PENG group VAS scores decreased notably post-procedure, reaching minimal levels at 2 h (0.00±0.00) and 6 h, compared to higher control group scores (e.g., 2.86±2.37 at 6 h, 4.95±1.47 at 24 h). With 15° leg elevation, VAS scores in the PENG group remained consistently lower at all intervals (e.g., 2.44±1.50 at 24 h vs. 7.14±1.24 in controls). PENG block patients required significantly less systemic analgesia, with reduced opioid consumption. No significant block-related complications, such as perioral tingling, metallic taste, dizziness, or seizures, were reported.(4,5) DISCUSSION: This study demonstrates that the PENG block provides superior and sustained pain relief for up to 24 hours compared to conventional systemic analgesics, both at rest and with movement. Reduced opioid consumption highlights its opioid-sparing benefits, minimizing associated adverse effects like nausea, respiratory depression, and sedation. Importantly, the procedure proved safe, with no observed complications, reinforcing the block's reliability. CONCLUSION: The PENG block is a safe, effective, and opioid-sparing analgesic intervention for hip fracture patients, enhancing comfort and reducing systemic analgesic requirements. This approach is particularly advantageous for elderly patients, offering improved outcomes and fewer adverse effects compared to traditional pain management strategies.