Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study

Abstract

Objectives: The pericapsular nerve group (PENG) block was first described for analgesia of hip fracture in 2018. We hypothesised that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the ED. Methods: This was an observational study of routine care. Consecutive patients receiving regional anaesthesia for hip fracture at a single ED were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 min after administration. Maximal reduction in pain scores within 60 min 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 h after regional anaesthesia and adverse events over the duration of admission. Results: There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 fascia iliaca compartment blocks, 14 femoral nerve blocks) and 19 received a PENG block. Inexperienced providers were able to successfully perform the PENG block. There was no difference in maximum pain score reduction between the groups. There was no difference in adverse effects between groups. Opioid use was similar between the groups. More patients were opioid-free after a PENG block. Conclusions: The present study demonstrated that the PENG block can be provided safely and effectively to patients with hip fracture in the ED. On the basis of this pilot study, a larger randomised controlled study should now be designed.

Large-scale Implementation of Fascia Iliaca Compartment Blocks in an Emergency Department

“…This was done through educational spaced repetition (an educational method to improve retention that uses a repeated review of content at different time intervals) at weekly emergency medicine conference, through access to online and written training materials, and through email communication detailing where staff physicians were in the credentialing process. 13 Departmental statistics on the percentage of eligible patients who received the nerve block were also communicated to EPs.…”

Unique considerations in regional anesthesia for emergency department and non-or procedures

“…The PENG block has also demonstrated an ability to provide superior analgesia comparable to FNB and FIB. [43][44][45] Notably, the LFCN is spared and can be added as an adjunct for cutaneous sensory coverage.…”

“…This block has been adopted in the ED for hip fractures and has been found to be feasible and effective even when performed by inexperienced providers. The PENG block has also demonstrated an ability to provide superior analgesia comparable to FNB and FIB 43–45 . Notably, the LFCN is spared and can be added as an adjunct for cutaneous sensory coverage.…”

Point‐of‐care ultrasound‐guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report

“…The point of care ultrasound (POCUS) guided pericapsular nerve group (PENG) block is an emerging regional anaesthesia technique that may be safely used to provide effective analgesia for these patients in the ED 3,4 . The PENG block, a variation of the iliopsoas plane block, was originally designed to improve perioperative analgesia in hip fracture 5 .…”

“…The point of care ultrasound (POCUS) guided pericapsular nerve group (PENG) block is an emerging regional anaesthesia technique that may be safely used to provide effective analgesia for these patients in the ED. 3 , 4 The PENG block, a variation of the iliopsoas plane block, was originally designed to improve perioperative analgesia in hip fracture. 5 This single‐shot block theoretically targets the articular branches of the femoral, obturator and accessory obturator nerve within the iliopsoas compartment, providing extensive coverage of the hip capsule with potential motor sparing, 6 although the obturator nerve branches may only be variably anaesthetised.…”