Pericapsular Nerve Group Block versus Femoral Nerve Block for Positioning During Spinal Anaesthesia in Patients with Hip Fracture: A Randomized Controlled Trial

Israt Jahan; Subrata Kumar Mondal; Rubayye Binte Sarwar; Kamrun Nahar; Sakib Intiser; Saifullah Al Kafi; Imtiaz Ahmed

doi:10.62848/bjpain.v6i1.1586

Authors

Israt Jahan Registrar, Department of Anaesthesia, Pain, Palliative & Intensive Care, DMCH, Dhaka https://orcid.org/0009-0005-0823-4930
Subrata Kumar Mondal Professor& Head, Department of Anaesthesia, Pain, Palliative & Intensive Care, DMCH, Dhaka
Rubayye Binte Sarwar Assistant Professor, Department of Anaesthesiology & ICU, Shaheed Monsur Ali Medical College, Uttara, Dhaka
Kamrun Nahar Medical Officer, OSD, DGHS, Mohakhali, Dhaka
Sakib Intiser Assistant professor, Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka
Saifullah Al Kafi Specialist (Critical Care Medicine), Department of Anaesthesia, Pain, Palliative & Intensive Care, DMCH, Dhaka
Imtiaz Ahmed Resident, Department of Anaesthesia, Pain, Palliative & Intensive Care, DMCH, Dhaka

DOI:

https://doi.org/10.62848/bjpain.v6i1.1586

Keywords:

Pericapsular Nerve Group block; Femoral Nerve Block; Hip fracture; Subarachnoid block; Positioning analgesia

Abstract

Background: Hip fractures are a leading cause of morbidity in elderly patients globally. Subarachnoid block (SAB) is the preferred anaesthetic technique for surgical repair, but positioning patients for SAB causes severe pain. Peripheral nerve blocks offer effective pre-procedural analgesia. The Pericapsular Nerve Group (PENG) block is a novel motor-sparing technique targeting articular branches of the anterior hip capsule, proposed as an alternative to the conventional Femoral Nerve Block (FNB). The objective of this study was to compare the analgesic efficacy of ultrasound-guided PENG block versus FNB for positioning patients with hip fracture prior to SAB.

Methods: A randomised controlled trial was conducted in Dhaka Medical College Hospital from August 2023 to March 2025. One hundred patients (aged 45–80 years, ASA I–II) were randomised: Group F (FNB, n=50) received 0.25% bupivacaine 10 mL + 1% lignocaine with adrenaline 5 mL (15 mL total); Group P (PENG block, n=50) received 0.25% bupivacaine 10 mL + 1% lignocaine with adrenaline 10 mL (20 mL total). Primary outcomes: VAS pain score at 30 minutes post-block and pain grade during SAB positioning. Secondary outcomes: best sitting angle, performer-rated positioning quality, haemodynamic parameters, and adverse events.

Results: Baseline demographics were comparable (p > 0.05). PENG block produced significantly lower VAS at 30 min (1.66±0.66 vs 2.98±1.30; p < 0.001); 100% of Group P achieved VAS <4 versus 70% in Group F (p < 0.001). Optimal sitting angle (>90°) was more frequent with PENG block (88% vs 58%; p = 0.002). Pain-free (Grade 1) positioning was achieved in 88% of Group P vs 36% of Group F (p < 0.001). Performer-rated positioning quality was superior in Group P (p = 0.007). Haemodynamic parameters and adverse event rates were comparable (p > 0.05). Number needed to treat for optimal sitting angle: 3.3.

Conclusion: PENG block is superior to FNB for pre-procedural analgesia in hip fracture patients undergoing SAB, providing better pain control, optimal positioning, and higher operator satisfaction without increased adverse effects. It should be considered the preferred regional technique for this indication at centres with ultrasound capability.