Assessing the clinical efficacy of the Pericapsular Nerve Group (PENG) block in hip fracture surgery

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Hip fractures are a common presentation to hospital in the elderly associated with significant morbidity and mortality. To reduce hip fracture associated morbidity and mortality it has been recommended that patients receive frequent pain assessment, multimodal analgesia and adequate analgesia to allow mobilisation day one post-operatively. Part of a balanced multimodal analgesia plan includes performing a regional nerve block such as a femoral nerve block or a fascia iliac nerve block to reduce the requirement for opioid analgesia, potentially reduced rates of delirium, and facilitate early mobilization provided they do not cause motor weakness. The current standard in treatment for regional anaesthesia is a femoral nerve block, however studies have not shown a great clinical reduction in pain scores and there is associated quadriceps muscle weakness potentially delaying mobility after surgery. This had led to an interest in the development of a regional nerve block which produces a more significant reduction in pain without causing motor weakness. An anatomical study in 2018 explored the sensory innervation of the hip joint which has led to the development of the Pericapsular Nerve Group (PENG) block, first described in the literature in late 2018. The literature surrounding PENG blocks is so far limited to small case series and editorials, however the reported studies show potentially positive results of improved pain scores and potentially a reduction in quadriceps weakness. The aim of this feasibility study was to evaluate the impact of this new regional technique on pain scores, opioid use, and quadriceps strength compared to the femoral nerve block.

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