Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Hip fractures are a common injury among the elderly and a substantial cause of morbidity and mortality worldwide. Pain management is an essential component of care for patients with hip fractures, particularly for improving patient outcomes. Ultrasound-guided nerve blocks such as the fascia iliaca block (FIB) are evidence-based means of providing perioperative analgesia and reducing opioid use. Newer nerve blocks, such as the pericapsular nerve group (PENG) block, may serve as alternatives to the FIB. The objective of this study was to retrospectively compare pain reduction following the PENG block and FIB in patients with hip fractures treated in our emergency department. Secondary objectives included block-related complications such as local anesthetic systemic toxicity (LAST), greater hospital length of stay, and increase in mortality.

Methods: The primary outcome measure was to investigate whether the PENG block is an effective alternative to FIB in achieving analgesia. Secondary objectives include data on rates of LAST, block complications, hospital length of stay, and mortality. We conducted a retrospective chart review on adult patients (≥18 years) with hip fractures who received either a FIB or PENG block between June 2021 and June 2023. Among the participants, pain scores (0–10 scale) were recorded before and after the block. Opioid use 24 hours postblock was also documented. We used generalized estimating equation modeling to compare pre-to-post block pain reduction between the FIB and PENG block groups.

Results: A total of 88 participants met inclusion criteria (73 FIB, 15 PENG). The mean (SD) preblock pain scores were 6.5 (2.1) for FIB and 7.9 (1.6) for PENG, improving to 4.4 (2.0) and 4.3 (2.1) postblock, respectively. Generalized estimating equation analysis revealed a statistically significant greater reduction in pain for the PENG group compared to FIB (mean difference = 1.42; 95% CI, 0.21–2.63; P = .02). In this study, there were no cases of local anesthetic systemic toxicity or other block-related complications observed (0%; 95% CI, 0%–3.4%).

Conclusion: Patients who received the PENG block achieved a greater reduction in pain scores compared to the FIB in this small retrospective cohort study. These findings suggest that the PENG block may be an effective alternative to FIB for analgesia in this setting. However, larger, prospective studies are needed to confirm these results. Given the study design and baseline differences in pain scores, these findings should be interpreted with caution.