Pericapsular nerve group (PENG) block vs femoral nerve block for pain control during spinal anaesthesia in hip surgeries- A randomized prospective trial

• Author Details:   
• Logesh Ravichandran ^*
• Shanmugavalli Ettiyan
• Suresh Rajkumar
• Ezhilrajan Vaithiyalingam

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Background and Aims: Hip fractures have a high incidence in the elderly population, often requiring surgical intervention under spinal anaesthesia. Achieving optimal patient positioning for this procedure is challenging due to severe pain, and effective analgesia is crucial for its success. This study aimed to compare the efficacy of the Pericapsular Nerve Group (PENG) block versus the Femoral Nerve Block (FNB) in providing analgesia for patient positioning during spinal anaesthesia for hip surgeries.

Materials and Methods: In this prospective, double-blind, randomized controlled trial, 80 patients scheduled for hip surgery were allocated using a computer-generated sequence to receive either a PENG block or an FNB (n=40 per group). Both groups received 20 mL of 0.25% bupivacaine 30 minutes before spinal anaesthesia. The primary outcome was the Visual Analog Scale (VAS) score during positioning. Secondary outcomes included the number of assistants required, time to perform the spinal block, duration of analgesia, time to mobilisation, patient satisfaction, and complications.

Results: The VAS score during positioning was significantly lower in the PENG group (1.93 ± 0.73) compared to the FNB group (3.35 ± 0.58) (p=0.001). Significantly fewer assistants were required for positioning in the PENG group. Furthermore, the PENG group demonstrated a shorter time to perform spinal anaesthesia, a longer duration of analgesia, earlier mobilization, and higher patient satisfaction, with no reported complications.

Conclusion: The PENG block provides superior analgesia to the FNB for patient positioning during spinal anaesthesia in hip surgery. This results in a significantly reduced requirement for assistance and lower patient pain scores. The PENG block also facilitates a better recovery profile, including prolonged analgesia and earlier mobilisation.