Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study.

BACKGROUND: Position changes due to the implementation of neuraxial anesthesia before hip fracture surgery may cause severe pain, and increases the occurrence of perioperative adverse events, especially for weak elderly patients with cardiovascular and other diseases. Iliaca fascia block (FICB) is commonly used method to control the pain caused by position changes, and has been proven to have a good analgesic effect. However, pain control is not ideal due to ultrasound positioning and fascia diffusion of anesthetic. The pericapsular nerve group (PENG) block is a new method for pain control after hip fracture surgery. And also performed in emergency departments for early multimodal analgesia and is increasingly being taught to emergency physicians[1, 2]. However, there are few studies on analgesia before spinal anesthesia in hip fracture surgery, and there is a lack of comparison of the analgesic effect and benefits between the PENG block and FICB in elderly patients with hip fracture. This study employed ultrasound-guided supra-inguinal fascia iliaca block (sFICB), aimed to compare the analgesic effects of PENG and sFICB before spinal canal block in elderly patients with hip fractures undergoing surgery.

METHODS: This was a single-center, observer-blind, prospective, and randomized controlled study. A total of 64 elderly patients with hip fractures ≥65 years old were enrolled. Before undergoing intrathecal block, the patients were randomly divided into 2 groups: P group (PENG block)and F group(sFICB block).

RESULTS: The success rate was 68.75 % in the F group, and 90.62 % in the P group (P < 0.05). Compared with the F group, the numeric rating scale (NRS) scores of the P group were significantly decreased (P < 0.05), and the time to perform the nerve block and spinal anesthesia were shorter (P < 0.05) in the P group. There was no significant difference in vital signs, pain relief, morphine consumption within 2 days after the operation, and adverse reactions between the 2 groups.

CONCLUSION: PENG block before spinal anesthesia has a better analgesic effect in elderly patients undergoing hip fracture surgery as compared to sFICB. The success rate of PENG is also significantly greater than that of sFICB.