Analgesic efficacy of Pericapsular Nerve Group (PENG) block compared with Fascia Iliaca Block (FIB) in the elderly patient with fracture of the proximal femur in the emergency room. A randomised controlled trial

Introduction and objectives: Data on the efficacy of PENG (Pericapsular Nerve Group) block in hip trauma pain are scarce. We hypothesized that PENG block was more effective than infra-inguinal ultrasound-guided FIB (Fascia Iliaca block) for pain control in patients aged 65 years or older presenting in the emergency room (ER) with traumatic proximal femoral fracture.Materials and methods: We conducted an exploratory, double-blind, randomized controlled trial. One anaesthesiologist performed the block and another assessed outcomes.Patients were randomly allocated to the PENG group (20 ml ropivacaine 0.375%) or the infrainguinal FIB group (40 ml ropivacaine 0.2%). Standard hypothesis tests (t test or chi(2) test) were performed to analyse baseline characteristics and outcome parameters. The primary end-point of the study was analgesic success, defined as << NRS pain score <= 4 >> 30 min after blockade, with PENG vs to FIB. Secondary outcomes were pain at rest (<< pain at rest NRS score <= 4 >> 30 min after blockade), duration of analgesia (time to first request for analgesia), need for rescue medication in case of block failure, and complications during blockade.Results: After obtaining ethical committee approval and written informed consent, 60 patients were included.The primary endpoint was achieved in 16 out of 30 patients (53.3%) in the PENG group and in 15 out of 28 patients (53.6%) in the FIB group. Comparison between groups did not show superiority of the PENG vs FIB (p = 0.98).Conclusions: PENG block does not provide better pain than FIB in proximal femoral fracture in elderly patients treated in the ER.