Study objective: We evaluated the efficacy and safety of ultrasound-guided pericapsular nerve group (PENG) block for initial pain management in adult emergency department (ED) patients with hip fractures.
Methods: This prospective, randomized, double-blinded, controlled trial was conducted at a tertiary care academic ED. Adult patients (≥ 18 years) with traumatic hip fractures and Numerical Rating Scale (NRS) pain scores > 4 were randomized to ultrasound-guided PENG block with bupivacaine or sham procedure. Both groups received standard intravenous analgesia. The primary outcome was the difference in NRS scores over 3 h. Secondary outcomes included total rescue analgesia (morphine equivalents) and adverse events.
Results: Of 167 screened, 80 patients were enrolled (40 per group). Pain scores were significantly lower in the PENG block group at 30 min (mean difference [MD] -3.2; 95% confidence interval [CI]-4.2 to -2.2), 60 min (MD -3.1; 95% CI -4.1 to -2.1), and 120 min (MD -2.0; 95% CI -2.6, -1.4), compared with sham. Total rescue analgesia was significantly lower in the PENG block group (MD -4.6 mg morphine equivalents; 95% CI -6.2 to -3.1). No significant adverse events were reported, such as hematoma, quadriceps weakness, signs of local anesthetic systemic toxicity (LAST), or significant opioid-related adverse events.
Conclusion: In adult ED patients with hip fractures, ultrasound-guided PENG block significantly reduced pain scores and opioid requirements compared with sham, with no significant adverse events reported. PENG block may be an effective, opioid-sparing analgesic strategy for acute hip fractures in the ED.
Trial registration: Clinical Trial Registry-India: CTRI/2023/08/056595.
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