Comparative Study Between Pericapsular Nerve Group Block (PENG) Versus Suprainguinal Fascia Iliaca Compartment Block (SIFIC) in Perioperative Hip Surgery

Comparative Study Between Pericapsular Nerve Group Block (PENG) Versus Suprainguinal Fascia Iliaca Compartment Block (SFIC) in Perioperative Hip Surgery

The hip joint is the largest and one of the most stable joints in the human body. It bears the majority of the body's weight during both dynamic and static activities, making it highly susceptible to degenerative diseases, particularly in the elderly population. In advanced cases, total hip arthroplasty (THA) is often required-currently ranking as the second most common joint replacement procedure worldwide.

Despite its clinical success, it is estimated that 7-28% of patients experience chronic postoperative pain following THA. This persistent pain significantly impairs quality of life and is receiving growing attention from healthcare professionals. Evidence suggests that unmanaged acute surgical pain is a major risk factor for the development of chronic postoperative pain, underscoring the importance of effective perioperative analgesia. Given the adverse effects associated with opioids, regional anesthesia techniques are increasingly favored for pain management.

Among these, the fascia iliaca compartment block (FICB) has been widely used to reduce postoperative pain intensity, although it carries potential drawbacks such as motor weakness or a need for supplemental opioid use. Recent anatomical studies by Short et al. have identified the anterior capsule of the hip joint as being innervated by the pericapsular nerve group (PNG) including the obturator nerve, accessory obturator nerve, and femoral nerve. The anatomical accessibility of these nerves has enabled the development of the pericapsular nerve group (PENG) block, a motor-sparing regional anesthesia technique that offers targeted analgesia by delivering local anesthetics into the myofascial plane between the psoas muscle and the superior pubic ramus.

While both FICB and PENG blocks are widely used in total hip replacement surgeries, comparative evidence evaluating their efficacy remains limited. Therefore, this study aims to compare the analgesic effectiveness of FICB and PENG blocks during the preoperative and postoperative phases of total hip arthroplasty.

Study Overview

• Status: Completed
• Conditions: Anesthesia; Nerve Block
• Intervention / Treatment: Procedure: Pericapsular Nerve Group Block (PENG); Procedure: Suprainguinal Fascia Iliaca compartment Block (SIFIC)

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt
      • Faculty of Medicine, Ain Shams University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• 40 years or older
• non-pathologic hip fractures
• underwent total hip arthroplasty (THA) or hemiarthroplasty at Ain Shams University Hospitals
• physical status I, II and III according to the American Society of Anesthesiologists (ASA) classification.

Exclusion Criteria:

• pathological fracture
• allergy to study drugs.
• ASA IV (a patient with severe systemic disease that is a constant threat to life)
• bleeding tendencies
• dementia or any mental disability
• having sepsis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ultrasound-guided pericapsular nerve group block PENG	Procedure: Pericapsular Nerve Group Block (PENG); Participants in the PENG group first received their study medication, administered over a 1-minute interval, 5 minutes prior to the initiation of spinal anesthesia. For the block itself, an in-plane ultrasound-guided approach was utilized. Following the creation of a skin wheal, an echogenic, 10-centimeter, 21-gauge needle was carefully advanced in a lateral-to-medial trajectory. The local anesthetic, 20 mL of .5% ropivacaine, was then accurately injected into the fascial plane located anterior to the psoas tendon and posterior to the pubic ramus.
Active Comparator: ultrasound-guided supra-inguinal fascia iliaca block SFIC	Procedure: Suprainguinal Fascia Iliaca compartment Block (SIFIC); The SFIC group block began with a skin wheal and employed an in-plane needle insertion. Once the needle successfully pierced the fascia iliaca, a small 2 mL volume of saline was initially injected. This served as a hydraulic confirmation of the correct needle tip placement within the compartment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
onset of analgesia	defined as an NRS of 3 or less at rest and during passive 20° limb elevation.	Assessed before the block and every 3 minutes from blocking for 30 minutes afterwards.

Secondary Outcome Measures

Outcome Measure	Time Frame
NRS over 24 hours	24 hours

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): September 1, 2023
• Study Completion (Actual): December 1, 2023

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Actual): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: FMASU M D 235/2020

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