PENG vs FICB for Hip Fracture in ED Patients

Study Overview
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Brief Summary
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Regional anesthesia for hip fractures has been shown to decrease rates of delirium in elderly patients with hip fractures as well as improve pain compared to systemic opioids. The Pericapsular Nerve Group (PENG) block has recently received attention as an alternative approach to femoral nerve block and Fascia Iliaca Compartment Block (FICB). The investigators seek to evaluate if there is a difference between the PENG and FICB in terms of efficacy of pain control in ED patients presenting with hip fracture. We hypothesize that the PENG block may be superior based on previous research.

Detailed Description
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Fractures of the proximal femur are a common presentation to the emergency department and are an acutely painful condition. This condition predominantly affects elderly patients who are at risk for delirium and more susceptible to the adverse effects of systemic opioids. Regional anesthesia is an recommended component of pain control for elderly patients with hip fracture. The investigators seek to compare the efficacy of pain control of the Pericapsular Nerve Group (PENG) block with the Fascia Iliaca Compartment Block (FICB). Previous studies have suggested that the PENG block may be superior to the FICB for pain control and results in less thigh motor weakness. The investigators will compare pain control (by difference in mean VAS score at set time points), systemic opioid use (in mean morphine equivalents prior to surgery), and motor function in patients with hip fractures who receive either block in the ED.

Official Title
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Comparison of Pericapsular Nerve Group Block (PENG) Versus Fascia Iliaca Compartment Block (FICB) for Hip Fracture Analgesia in Emergency Department Patients

Conditions
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Femoral Neck Fractures, Intertrochanteric Fractures

Intervention / Treatment
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* Procedure: PENG
* Procedure: FICB


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Proximal femur fracture Exclusion Criteria: refusal to consent hemodynamic instability allergy to local anesthetics severe injury with instability severe medical conditions with instability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients will be randomized to receive either a PENG or FICB. Baseline characteristics will be collected and VAS pain scores collected preblock and at specified time points post block.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PENG<br>Patients with hip fracture randomized to receive PENG block | Procedure: PENG<br>* patients will receive an ultrasound-guided Pericapsular Nerve Group Block with 20mL of 0.25% bupivacaine (not to exceed 2mg/kg)<br>|
| Active Comparator: FICB<br>Patients with hip fracture randomized to received FICB | Procedure: FICB<br>* Patients will receive an ultrasound-guided Fascia Iliaca Compartment Block with 20 mL of 0.25% bupivacaine (not to exceed 2 mg/kg) diluted to total volume of 40 mL of injectate<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain score | Mean pain score on a 100 mm VAS Range 0-100 mm with 0 representing no pain and 100 mm representing severe pain | 6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid use | Mean opioid consumption in morphine equivalents | 6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PENG, FICB, Fascia Iliaca Compartment Block, Pericapsular Nerve Group Block, Hip fracture