Pericapsular Nerve Group Block Versus Femoral Nerve Block Study

Comparison of Preoperative Pericapsular Nerve Group (PENG) Block Versus Femoral Nerve Block for Optimizing Spinal Anaesthesia in Proximal Femur Fracture Surgery: A Prospective Randomized Controlled Trial

Hip fractures are common in older adults and are often associated with severe pain, making it difficult for patients to sit for spinal anesthesia before surgery. Peripheral nerve blocks may improve pain control and facilitate patient positioning, but it remains uncertain whether the Pericapsular Nerve Group (PENG) block provides advantages over the traditional femoral nerve block during the spinal anesthesia procedure.

Study Overview

• Status: Not yet recruiting
• Conditions: Hip Fractures
• Intervention / Treatment: Procedure: Ultrasound-Guided Pericapsular Nerve Group (PENG) Block; Procedure: Spinal Anesthesia (bupivacaine); Procedure: Ultrasound-Guided Femoral Nerve Block

Detailed Description

Hip fractures are among the most common injuries in older adults and are associated with substantial morbidity, mortality, and healthcare utilization. Spinal anesthesia is frequently used for surgical repair of proximal femur fractures because of its favorable safety profile in elderly patients. However, severe pain caused by the fracture often makes positioning for spinal anesthesia difficult, resulting in patient discomfort, prolonged procedure time, multiple needle insertion attempts, and increased procedural complexity.

Peripheral nerve blocks are increasingly used before spinal anesthesia to improve analgesia and facilitate patient positioning. The femoral nerve block (FNB) has long been established as an effective regional anesthesia technique for patients with hip fractures. More recently, the ultrasound-guided Pericapsular Nerve Group (PENG) block has been introduced as a motor-sparing technique targeting the articular branches of the femoral, obturator, and accessory obturator nerves that innervate the anterior hip capsule. Previous studies have demonstrated that the PENG block provides effective analgesia during positioning for spinal anesthesia and may offer superior pain relief compared with conventional techniques. However, evidence comparing the effects of PENG block and femoral nerve block on the technical performance of spinal anesthesia and perioperative hemodynamic stability remains limited.

This prospective, randomized controlled trial is designed to compare ultrasound-guided PENG block with ultrasound-guided femoral nerve block in patients undergoing surgery for proximal femur fracture under spinal anesthesia. The study will evaluate whether PENG block improves procedural conditions for spinal anesthesia compared with femoral nerve block while also assessing perioperative analgesia and hemodynamic responses.

The study hypothesis is that preoperative PENG block will provide better procedural conditions for spinal anesthesia than femoral nerve block by improving patient positioning, reducing pain during positioning, facilitating spinal needle placement, decreasing the need for supplemental analgesic or sedative medication, and contributing to greater perioperative hemodynamic stability.

• Study Type: Interventional
• Enrollment (Estimated): 110
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Celal Kaya, MD; Phone Number: 90 5435176760; Email: c.kaya47@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Beyoglu
    • Istanbul, Beyoglu, Turkey (Türkiye)
      • Taksim Training and Research Hospital
      • Contact: celal kaya, MD; Phone Number: 90 5435176760; Email: celalmadime@gmail.com
      • Contact: Guray Demir, Proffesor; Phone Number: 90 5052113989; Email: guraydemir@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 50 years or older.
• Diagnosis of proximal femoral fracture.
• Scheduled to undergo surgical repair under spinal anesthesia.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Able to provide written informed consent.

Exclusion Criteria:

• Refusal to participate or inability to provide informed consent.
• Coagulopathy or contraindication to spinal anesthesia or peripheral nerve block.
• Local infection at the planned injection site.
• Known allergy or hypersensitivity to local anesthetics.
• Pre-existing neurological disease affecting lower extremity function or sensory assessment.
• Cognitive impairment preventing reliable study participation or outcome assessment.
• Previous lumbar spine surgery.
• Polytrauma.
• Body mass index (BMI) <18 kg/m² or >40 kg/m².
• Current anticoagulant therapy that precludes neuraxial anesthesia or peripheral nerve block according to institutional practice.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: PENG Block; Participants will receive a preoperative ultrasound-guided Pericapsular Nerve Group (PENG) block with 20 mL of 0.25% bupivacaine before spinal anesthesia for proximal femur fracture surgery. Spinal anesthesia will subsequently be performed according to the standardized study protocol.	Procedure: Ultrasound-Guided Pericapsular Nerve Group (PENG) Block; Ultrasound-guided PENG block performed before spinal anesthesia using 20 mL of 0.25% bupivacaine to provide analgesia for patients undergoing surgery for proximal femur fracture.; Procedure: Spinal Anesthesia (bupivacaine); Standard spinal anesthesia performed after the assigned peripheral nerve block using intrathecal hyperbaric bupivacaine according to the study protocol.
Active Comparator: Femoral Nerve Block; Participants will receive a preoperative ultrasound-guided femoral nerve block with 20 mL of 0.25% bupivacaine before spinal anesthesia for proximal femur fracture surgery. Spinal anesthesia will subsequently be performed according to the standardized study protocol.	Procedure: Spinal Anesthesia (bupivacaine); Standard spinal anesthesia performed after the assigned peripheral nerve block using intrathecal hyperbaric bupivacaine according to the study protocol.; Procedure: Ultrasound-Guided Femoral Nerve Block; Ultrasound-guided femoral nerve block performed before spinal anesthesia using 20 mL of 0.25% bupivacaine to provide analgesia for patients undergoing surgery for proximal femur fracture.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Spinal Anesthesia Convenience Score (SACS)	Spinal anesthesia convenience will be assessed using the Spinal Anesthesia Convenience Score (SACS), a composite clinical score evaluating the ease of spinal anesthesia based on anatomical landmark palpation, patient cooperation, sitting position quality, pain during passive hip flexion, and pain while maintaining the sitting position. Total scores range from 0 to 11, with higher scores indicating easier spinal anesthesia conditions.	During spinal anesthesia procedure (immediately after patient positioning and before initiation of surgery)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
First-Attempt Success of Spinal Anesthesia	The proportion of participants in whom successful intrathecal access is achieved on the first needle insertion attempt.	During the spinal anesthesia procedure.
Number of Spinal Needle Insertion Attempts	The total number of spinal needle insertion attempts required to achieve successful spinal anesthesia.	During the spinal anesthesia procedure.
Duration of Spinal Anesthesia Procedure	Time from the beginning of patient positioning until completion of spinal anesthesia and return to the supine position, measured in minutes.	During the spinal anesthesia procedure.
Anxiety Score	Patient anxiety will be assessed using an 11-point Numeric Rating Scale (NRS) ranging from 0 (no anxiety) to 10 (maximum anxiety). Lower scores indicate less anxiety.	Before peripheral nerve block, 30 minutes after block placement, and immediately before surgical incision (after spinal anesthesia).
Patient Satisfaction	Patient satisfaction with the anesthesia process will be assessed using a Numeric Rating Scale ranging from 0 (not satisfied at all) to 10 (completely satisfied). Higher scores indicate greater satisfaction.	Postoperative Day 0 (before discharge from the post-anesthesia care unit [PACU])
Anesthesiologist Satisfaction	The anesthesiologist's satisfaction with procedural conditions will be assessed using a Numeric Rating Scale ranging from 0 (not satisfied at all) to 10 (completely satisfied). Higher scores indicate greater satisfaction.	Immediately after completion of spinal anesthesia.
Perioperative Hemodynamic Parameters	Mean arterial blood pressure will be recorded throughout the perioperative period.	Before peripheral nerve block; 1, 5, 10, 15, and 30 minutes after block placement; and 1, 5, 10, 15, and 30 minutes after spinal anesthesia.
Incidence of Hypotension	Hypotension is defined as a mean arterial pressure below 65 mmHg. The proportion of participants experiencing hypotension will be recorded.	From spinal anesthesia until 30 minutes after surgery completed.
Vasopressor Requirement	Total intravenous ephedrine dose administered for the treatment of hypotension, measured in milligrams.	From spinal anesthesia until 30 minutes after surgery completed.
Additional Analgesic Medication Requirement	Total doses of intravenous fentanyl (micrograms) administered during positioning for spinal anesthesia.	During the spinal anesthesia procedure.
Additional Sedative Medication Requirement	Total doses of intravenous midazolam (milligrams) administered during positioning for spinal anesthesia.	During the spinal anesthesia procedure.

Collaborators and Investigators

• Sponsor: Taksim Egitim ve Arastirma Hastanesi
• Investigators: Principal Investigator: Celal Kaya, Taksim Training and Research Hospital

Publications and helpful links

General Publications

• Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.
• Messina A, La Via L, Milani A, Savi M, Calabro L, Sanfilippo F, Negri K, Castellani G, Cammarota G, Robba C, Morenghi E, Astuto M, Cecconi M. Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis. J Anesth Analg Crit Care. 2022 May 8;2(1):19. doi: 10.1186/s44158-022-00047-6.
• Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76-81. doi: 10.1016/j.ajem.2008.09.015.
• Erten E, Kara U, Simsek F, Eskin MB, Bilekli AB, Ocal N, Senkal S, Ozdemirkan I. Comparison of pericapsular nerve group block and femoral nerve block in spinal anesthesia position analgesia for proximal femoral fractures in geriatric patients: a randomized clinical trial. Ulus Travma Acil Cerrahi Derg. 2023 Dec;29(12):1368-1375. doi: 10.14744/tjtes.2023.33389.
• Lin DY, Brown B, Morrison C, Kroon HM, Jaarsma RL. Pericapsular nerve group block results in a longer analgesic effect and shorter time to discharge than femoral nerve block in patients after hip fracture surgery: a single-center double-blinded randomized trial. J Int Med Res. 2022 Mar;50(3):3000605221085073. doi: 10.1177/03000605221085073.
• 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 (Estimated): July 20, 2026
• Primary Completion (Estimated): December 10, 2026
• Study Completion (Estimated): December 20, 2026

Study Registration Dates

• First Submitted: July 6, 2026
• First Submitted That Met QC Criteria: July 16, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 16, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Hip Fracture; Regional Anesthesia; Femoral Nerve Block; Spinal Anesthesia; Pericapsular Nerve Group Block; Hemodynamic Stability
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Fractures, Bone; Femoral Fractures; Hip Injuries; Hip Fractures; Organic Chemicals; Anilides; Amides; Aniline Compounds; Amines; Anesthesia and Analgesia; Digestive System and Oral Physiological Phenomena; Anesthesia, Conduction; Anesthesia; Dentistry; Dental Physiological Phenomena; Bupivacaine; Anesthesia, Spinal; Dental Occlusion
• Other Study ID Numbers: E-48670771-514.99-317908988

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no current plan to share individual participant data (IPD). Future data sharing may be considered upon reasonable request and subject to approval by the sponsor, institutional policies, and applicable ethical and legal requirements.

Drug and device information, study documents

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