Pericapsular nerve group (PENG) block for hip fracture in the emergency department: a case series

Abstract

Guidelines for the management of hip fractures recommend timely identification, analgesia and optimisation, in order to facilitate prompt surgical repair. In achieving these aims, multidisciplinary care is essential. In this case series, we present five patients who received bedside pericapsular nerve group (PENG) blocks by emergency physicians in collaboration with the anaesthesia team for pain management following hip fracture. The PENG block is a novel motor- and opioid-sparing technique, which offers long-lasting analgesia and requires less volume than other blocks. In all of the cases in this series, the blocks were performed successfully in a short period of time, without complication. All patients reported a clinically important reduction in pain scores. Patients with hip fracture are often medically complex, and while early surgery is not always possible, pain management should be addressed from an early point in their hospital admission. Multidisciplinary input into peri-operative pathways can enhance the provision of analgesia in the emergency department, by allowing anaesthetists and emergency physicians to work together for the benefit of these often-frail patients.

Keywords: analgesia; hip fracture; nerve block; pain management.

© 2021 Association of Anaesthetists.

Figures

Figure 1

(a) Orientation of the ultrasound probe in the hip. S, superior; I, inferior. (b) Sonoanatomy. The dotted line depicts needle trajectory. FV; femoral vessels; IPE, iliopubic eminence; PT, psoas tendon; AIIS, anterior inferior iliac spine.