Effect of Preoperative PENG Block on Spinal Anesthesia Positioning and Postoperative Analgesia in Hip Fracture Surgery

A Randomized Controlled Trial Evaluating the Effect of Preoperative Pericapsular Nerve Group (PENG) Block on Positioning for Spinal Anesthesia and Postoperative Analgesia in Patients Undergoing Hip Fracture Surgery

Hip fractures are among the most common orthopedic traumas, particularly in elderly patients, and are usually associated with significant pain during positioning for spinal anesthesia. Adequate pain control during positioning can improve patient comfort and facilitate successful administration of anesthesia. The pericapsular nerve group (PENG) block has recently been introduced as a regional anesthesia technique that targets articular branches of the femoral, obturator, and accessory obturator nerves, and has been proposed as a method to reduce pain related to hip fracture positioning.

This study is designed to compare the efficacy of preoperative PENG block versus no block in patients undergoing proximal femoral nailing surgery under spinal anesthesia. The primary objective is to assess its effect on positioning pain using visual analog scale (VAS) scores. Secondary objectives include evaluating its impact on postoperative analgesic consumption, time to first rescue analgesic, and potential side effects.

This is a prospective, single-center, randomized controlled trial conducted at the University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital. A total of 60 patients, aged 18-90 years, with ASA I-III status, scheduled for proximal femoral nailing (PFN) surgery due to hip fracture, were enrolled. Patients were randomized into two groups using a sealed-envelope method:

PENG Block Group: Received a preoperative ultrasound-guided pericapsular nerve group (PENG) block 30 minutes before spinal anesthesia.

Control Group: Received no block prior to spinal anesthesia.

Standard spinal anesthesia was performed in both groups. All patients received intravenous paracetamol for postoperative analgesia at regular intervals. Additional analgesia with intravenous tramadol was administered if VAS ≥ 4.

The following parameters were collected:

Demographics (age, sex, BMI, ASA status, comorbidities)

Hemodynamic variables (SBP, DBP, HR, SpO₂) at baseline and during perioperative period

VAS scores at baseline, during positioning, and at postoperative time intervals (0, 15, 30 minutes, and 1, 2, 6, 12, and 24 hours)

Time to first rescue analgesic

Total opioid consumption in the first 24 hours postoperatively

Side effects such as nausea, vomiting, or other complications

The study aims to test the hypothesis that PENG block can reduce pain during positioning for spinal anesthesia and may improve postoperative analgesia in patients undergoing hip fracture surgery.

Inclusion Criteria:

• Patients aged 18 to 90 years

  • ASA (American Society of Anesthesiologists) physical status classification I-III
  • Scheduled for proximal femoral nailing due to hip fracture
  • Able to provide informed consent (or consent provided by a legal representative)
  • Willingness to comply with study procedures and follow-up assessments

Exclusion Criteria:

• - ASA physical status classification IV or V
• Refusal to provide informed consent
• Coagulopathy or current use of anticoagulant therapy contraindicating neuraxial block
• Local infection at the injection site
• Known allergy or hypersensitivity to local anesthetic agents
• Cognitive impairment or inability to cooperate with study procedures
• Severe psychiatric illness preventing reliable pain assessment
• Previous surgery or deformity of the hip interfering with block performance
• Pregnancy or lactation