PENG Block: A superior alternative for pain management in intracapsular hip fractures

Background and Objectives: Previous studies have demonstrated the effectiveness of regional analgesic techniques for pain management after hip surgery; however, no clear superiority between these techniques has been established. A key limitation of these studies is the lack of differentiation between fracture subtypes. This prospective, comparative cohort study aims to evaluate the effectiveness of two regional techniques—pericapsular nerve group block (PENG) and suprainguinal iliac fascia block (FICB)—in providing perisurgical analgesia for intracapsular femoral fractures. Materials and Methods: Sixty-four patients undergoing elective surgery for intracapsular femoral fractures were randomly assigned to receive either a PENG block or an FICB block, each with 15 mL of 0.2% ropivacaine. Intradural anesthesia and conventional intravenous analgesia were administered during surgery. The primary outcome was pain scores in the recovery room and 24 hours post-surgery. Secondary outcomes included the need for intravenous opioid rescue medication during the first 24 hours. Results: The PENG group demonstrated significantly lower postoperative pain scores compared to the FICB group both immediately after surgery ( P = 0.006) and at 24 hours ( P < 0.001). Additionally, fewer patients in the PENG group required weak opioids in the first 24 hours following surgery ( P = 0.001). Conclusions: The PENG block provides superior postoperative analgesia for intracapsular femoral fractures compared to the FICB block following hip surgery, with reduced opioid consumption observed in the PENG group. Clinical Trial Registration: NCT05377541.