Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

Background The pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB). Methods From October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse events over the duration of their admission. Results There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 FICB, 14 FNB) and 19 received a PENG block. There was no difference in maximum pain score reduction between the groups whether measured at rest or on movement. Clinicians providing the PENG block were less experienced in the technique than those providing FICB or FNB. There was no difference in adverse effects between groups. Although opioid use was similar between the groups, more patients were opioid free after a PENG block. Conclusions Although there was no difference in maximal pain score reduction, this study demonstrated that the PENG block was feasible and could be provided safely and effectively to patients with hip fracture in the ED. On this basis, a larger randomised controlled study should now be designed. Key Messages What is already known on this subject □ There is a solid neuroanatomical rationale to suggest the PENG block may provide superior anaesthesia of hip fractures than FNB or FICB. □ The technique utilises bony sonographic and tactile landmarks which make it an ideal block for emergency physicians to safely and effectively perform. □ What this study adds □ This is the first comparative study of the PENG block to FNB or FICB in patients with hip fracture in ED, which will provide a scaffold for future research. □ This pragmatic observation of evolving practice showed that emergency physicians and trainees inexperienced in the technique could provide it safely and effectively in the ED