Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial

• Published in: The American journal of emergency medicine Vol. 81; pp. 99 - 104
• Main Authors: Sahoo, Sangeeta, Sahoo, Nishit Kumar, Hansda, Upendra, Patro, Saroj Kumar, Sahu, Ajitesh, Mohanty, Chitta Ranjan, Das, Subhasree, Muhammed Shaji, Ijas, Behera, Shri Hari Priya
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Analgesia; Analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthetics; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Bupivacaine; Bupivacaine - administration & dosage; Bupivacaine - therapeutic use; Delirium; Emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Fractures; Hip; Hip fracture; Hip Fractures; Humans; Intervention; Intravenous Nalbuphine; Local anesthesia; Male; Middle Aged; Morphine; Nalbuphine - administration & dosage; Nalbuphine - therapeutic use; Narcotics; Nerve Block - methods; Opioids; Pain; Pain Management - methods; Pain Measurement; Pain perception; Patient satisfaction; PENG block; Ultrasonic imaging; Ultrasonography, Interventional - methods; Ultrasound; Intravenous Nalbuphine; Hip fracture; Emergency department; PENG block
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2024.04.016

The study aimed to compare the analgesic effect of USG-guided PENG (Peri capsular nerve group) block with Intravenous Nalbuphine hydrochloride (IVN) in patients with hip fracture coming to the emergency department (ED). The purpose was also to monitor the adverse effects and rescue analgesic requirements in both treatment modalities. The study was an open-label randomised controlled trial (RCT) comparing PENG block versus IVN in treating patients with femoral head and neck fractures, as well as pubic rami fracture of the hip (HF). The participants in the PENG group received a USG-guided PENG block by injection of 25 ml of 0.25% bupivacaine, whereas the IVN group received 0.15 mg/kg of nalbuphine. An emergency physician with expertise in ultrasound-guided nerve blocks performed the PENG blocks. The primary outcome was to measure the improvement of the NRS (Numerical rating scale) score at 30 min in both static position (Patient-chosen position for the best comfort) and dynamic position (15-degree passive affected lower limb elevation). Secondary outcomes were to measure static and dynamic NRS pain scores at 2 h, 4 h, and 6 h after intervention in both groups. The requirement for rescue analgesia, adverse events and any block-related complications were also recorded. A total of 60 patients with HF were included in the final analysis. The static and dynamic NRS score was significantly lower in the PENG group compared to the IVN group at 30 min, 2 h, 4 h, and 6 h post-intervention. In the PENG group, the static NRS score was improved by 5.73 ± 1.17, while In the IVN group, the static NRS score was just improved by 2.13 ± 0.97 at 30 min. In the same duration, the Dynamic NRS score in the PENG group was improved by 6.13 ± 1.38, while In the IVN group, it improved just by 2.43 ± 1.28. Rescue analgesia was required in 50.0% of patients in the IVN group but none in the PENG group. Further, no block-related complications or adverse events were observed in the patients of the PENG group. The study provides evidence that the ultrasound-guided PENG block has a better analgesic effect and has fewer adverse events than IV opioids in patients with HF.