The effect of pericapsular nerve group (PENG) block on postoperative analgesia in elderly patients who underwent proximal femoral nail anti-rotation surgery: a prospective, randomized-controlled trial.

Background: As a fascial plane block technique, further exploration is needed to determine the safety and efficacy of a peri-capsular nerve group (PENG) block in elderly patients with intertrochanteric femur fractures. We aimed to evaluate whether opioid consumption during a PENG block is better than a conventional opioid-based program for postoperative pain management after proximal femoral nail anti-rotation (PFNA).

Methods: We conducted a prospective, randomized, controlled trial comparing the efficacy of the PENG block with the control group for elderly patients undergoing primary PFNA under general anesthesia. The primary outcome was the cumulative administration of sufentanil during the first 48 h after surgery.

Results: 110 participants (55 in each group) were included in the analysis. Cumulative Sufentanil consumption between the PENG group and the control group at 48 h was 132.6 ± 12.3 vs. 141.0 ± 15.3, with a difference of -8.4; 95% CI, -13.6 to -3.1, P = 0.002. Sufentanil consumption at 24 h was 78.3 ± 6.1 vs. 94.0 ± 10.2, with a difference of -15.7; 95% CI, -18.9 to -12.5, P < 0.001. There were statistical differences in the visual analogue scale score trajectories between the two groups at 48 h postoperatively (P < 0.001). The median time to first remedial analgesia was lower in the PENG block group than in the control group (P < 0.001). However, there was no difference in the time to first standing.

Conclusion: Incorporating the PENG block into a multimodal analgesia regimen can decrease opioid consumption among elderly patients undergoing PFNA under general anesthesia.

Trial Registration: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054290, principal investigator: Xiao-dan, Wu, 13/12/2021).