Pericapsular Nerve Group Block-Augmented Analgesia vs. Conventional Opioid Analgesia for Hip Fracture Patients in the...

While opioids are frequently used in the emergency department (ED) for pain control of hip fractures, they are associated with poor side effects. The pericapsular nerve group (PENG) block has recently emerged as an opioid-sparing peripheral nerve block for patients with hip fractures.

The primary objective was to determine whether there is a reduction in morphine milligram equivalents (MME) administered to patients with hip fractures who receive a PENG block in the ED as compared to those who only receive opioids. Secondary outcomes included hospital length of stay and discharge disposition.

A retrospective study of patients with isolated hip fractures was performed at a level 1 urban trauma center. Thirty-six patients received a PENG block and 251 patients did not. Patients who received a PENG block were propensity-score matched against those who received opioids. The primary outcome was subsequent cumulative opioid administration.

Patients who received a PENG block had a statistically significant reduction in opioid administration. At 6 hours of follow-up, these patients had a reduction in MME by -0.14 MME/kg (95% CI: -0.20, -0.08), and at 18 hours of follow-up, this reduction was -0.14 MME/kg (95% CI: -0.23, -0.04). Secondary outcomes demonstrated comparable effects on length of stay and discharge disposition.

Emergency physician-performed PENG blocks are an effective opioid-sparing analgesic strategy for isolated hip fractures. Larger prospective studies are needed to evaluate this effect estimate and assess mortality outcomes.