PENG vs Femoral Block for Hip Fracture, A Pragmatic Cluster-Randomized Study
Weill Medical College of Cornell University
Summary
This study aims to compare the Pericapsular Nerve Group (PENG) block with femoral block for hip fracture pain. Participants presenting to the hospital with a diagnosis of hip fracture and consenting to analgesic block will receive either a PENG or femoral block. The choice of block will be dictated by a randomized monthly schedule, and all participants presenting during each four-week period will receive the designated block. A sub-group analysis will be performed to determine any difference in efficacy in participants with intracapsular versus extracapsular fractures.
Description
Each year, 250,000 adults in the US and 1.6 million worldwide suffer hip fractures. Peripheral nerve blocks, including femoral blocks, administered soon after admission to patients presenting with hip fractures have been shown to produce clinically and statistically significant reductions in pain scores, opioid consumption, the incidence of confusional state, and the time to mobilization. Historically, lower extremity blocks for hip fracture pain have targeted the femoral nerve. The PENG block is a relatively novel ultrasound guided block that was first described in 2018 as an alternative to…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Male or female ≥ 18 years of age. 2. ASA Classification 1-4 3. Documentation of a hip fracture diagnosis along with radiologic read indicating fracture location 4. Written, informed consent for analgesic peripheral block placement Exclusion Criteria: 1. Altered mental status to the extent that it limits ability to report pain score 2. Patient or health care proxy refusal of analgesic nerve block 3. Allergy to study medications or contraindication to peripheral nerve block 4. Chronic pain diagnosis on preoperative opioids
Interventions
- ProcedurePENG Block Administration
Policy for the PENG block administration: 30 mL of Bupivacaine 0.25% 1:200,000 epinephrine Dexamethasone 4 mg% While these drugs are administered to participants, the intervention under evaluation is the PENG Block anesthesia technique.
- ProcedureFemoral Block Administration
Policy for the Femoral block administration: 30 mL of Bupivacaine 0.25% 1:200,000 epinephrine Dexamethasone 4 mg While these drugs are administered to participants, the intervention under evaluation is the Femoral Block anesthesia technique.
- DrugBupivacaine , epinephrine Dexamethasone
30 mL of Bupivacaine 0.25% 1:200,000 epinephrine Dexamethasone 4 mg%
Location
- Weill Cornell MedicineManhattan, New York