Pericapsular Nerve Group (PENG) Block on Pain During Participant Positioning for Spinal Anesthesia in Hip Fracture Surgery

Effect of Ultrasound (USG)-Guided Pericapsular Nerve Group (PENG) Block on Pain During Participant Positioning for Spinal Anesthesia in Hip Fracture Surgery: a Randomized Controlled Trial

Hip fracture surgery is a common orthopedic procedure, especially in elderly patients. These fractures are quite common in adults over the age of 65, and the one-year mortality rate ranges from 12% to 37%. Recent studies have suggested that general anesthesia and spinal anesthesia are not superior to each other in patients undergoing hip fracture surgery. Untreated/poorly managed perioperative pain is directly linked to delirium, poor prognosis, and secondary chronic pain in hip fracture patients. Therefore, considering the associated mortality, morbidity, and early recovery, control of perioperative pain should be one of the highest priorities of the anesthesiologist, regardless of the anesthesia method used.

Study Overview

• Status: Completed
• Conditions: Hip Surgery; Femur Fracture

Detailed Description

Ultrasonography (USG)-guided regional anesthesia techniques are often used as part of multimodal analgesia in the management of perioperative pain in patients with hip fractures. One of the most recently described blocks used in hip fracture surgery, the USG-guided pericapsular nerve group (PENG) block, aims to directly block the articular branch of the femoral nerve, the articular branch of the obturator nerve, and the accessory obturator nerve, which selectively innervates the anterior aspect of the hip capsule. Case reports and a limited number of clinical studies have reported that PENG block is effective in managing acute fracture-related pain, neuraxial anesthesia positioning pain, and postoperative pain in hip fracture patients.

In this study, investigators aimed to investigate the effect of USG-guided PENG block on positional pain before spinal anesthesia in patients undergoing surgery for hip fractures and to compare this effect with intravenous ketamine.

In addition, investigators aimed to investigate the effect of PENG block on pain scores, perioperative opioid consumption, time to first analgesic requirement in the postoperative period, and quality of recovery in the first 24 hours after surgery.

• Study Type: Observational
• Enrollment (Actual): 62

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Istanbul Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

A total of 60 participants older than the age of 40 who will undergo hip fracture surgery under spinal anesthesia will be included in the study.

Description

Inclusion Criteria:

hip fracture aged between 35 and 90 years old

Exclusion Criteria:

contraindications for spinal anesthesia and PENG block impaired cognition or dementia multiple fractures any previous analgesic administration during the last 12 hours

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Procedure: PENG Block Pericapsular Nerve Group Block; Active Comparator: PENG Block For patients with hip fracture and having hip surgery this study evaluates the analgesic effects of Pericapsular Nerve Group (PENG) block for positioning before spinal anesthesia.
Drug: Conventional intravenous sedoanalgesia (ketamine) standardised intravenous sedoanalgesia agent; Active Comparator: Control in this group, standardised sedoanalgesia doses (drug: ketamine) will be used for analgesia for positioning pain

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain scores on the Numeric Rating Scale (NRS)	Changes in Numeric Rating Scale (NRS) at rest and on movement will be recorded at intervals. NRS is a unidimensional measure of pain intensity in adults. The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable").	Group A: 5 minutes after intervention (intravenous opioid), Group B: 20 minutes after intervention (PENG block)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of spinal anesthesia performance	It will be measured in "minutes", from the start of positioning maneuvers to the spinal needle removal	Group A: 5 minutes after intervention (intravenous ketamine), Group B: 20 minutes after intervention (PENG block)
Quality of patient's position	The position will be characterized as "unsatisfactory", "satisfactory", "good" or "very good"	Group A: 5 minutes after intervention (intravenous ketamine), Group B: 20 minutes after intervention (PENG block)
Analgesic consumption	In the postoperative period, patients will be given opioids according to their pain density with a rescue analgesia agent (tramadol).	24 hours

Collaborators and Investigators

• Sponsor: Marmara University

Publications and helpful links

General Publications

• Aygun H, Tulgar S, Yigit Y, Tasdemir A, Kurt C, Genc C, Bilgin S, Senoglu N, Koksal E. Effect of ultrasound-guided pericapsular nerve group (PENG) block on pain during patient positioning for central nervous blockade in hip surgery: a randomized controlled trial. BMC Anesthesiol. 2023 Sep 15;23(1):316. doi: 10.1186/s12871-023-02245-3.

Study record dates

Study Major Dates

• Study Start (Actual): November 20, 2024
• Primary Completion (Actual): May 20, 2025
• Study Completion (Actual): May 26, 2025

Study Registration Dates

• First Submitted: December 9, 2024
• First Submitted That Met QC Criteria: February 6, 2025
• First Posted (Actual): February 7, 2025

Study Record Updates

• Last Update Posted (Actual): May 29, 2025
• Last Update Submitted That Met QC Criteria: May 27, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: regional anesthesia; peng block; geriatric population
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Hip Injuries; Fractures, Bone; Femoral Fractures; Hip Fractures
• Other Study ID Numbers: E-10840098-202.3.02-6997

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No