PENG, fascia-iliaca compartment block or femoral nerve block for pain management of patients with hip fractures.
Systematic Review
Currently three types of regional nerve blocks are commonly administered to provide analgesia to patients with hip fractures; the Fascia-Iliaca Compartment Block (FICB), Femoral Nerve Block (FNB) and Pericapsular Nerve Group Block (PENG). It is unclear which of these provides the best analgesia and the lowest number of complications./r/nThis systematic review aims to evaluate the literature concerning the efficacy and safety of pre-operatively placed PENG block compared to FICB and FNB for hip fractures./r/nThe PRISMA statement guidelines were used and a systematic search of MEDLINE (via Ovid), Embase, Web of Science and Google Scholar was performed until April 8th, 2024./r/nOut of 118 identified studies, 17 (14 RCTs, 3 observational) met the inclusion criteria, of which 5 exhibited a low risk of bias. Pain scores were significantly lower with the PENG block compared to FICB/FNB in 12 of 17 studies, while 5 reported no difference. Opioid use was lower in 4 of 11 studies favoring PENG, while the other 7 showed no differences with FICB/FNB. Patient satisfaction was found to be higher in PENG in 5 studies, while 2 other reported no difference. Ease of spinal positioning was better with PENG in 4 studies, with 3 reporting no difference. Adverse events showed no significant differences between blocks. None of the studies found FNB or FICB to be favorable on any of these outcomes./r/nPENG block may be a promising technique to provide analgesia to patients with hip fractures. However, there was significant heterogeneity in endpoints used and in outcomes of the various studies that compared PENG with FNB or FICB blocks. Also, only one study was conducted in the emergency department (ED). Larger randomized controlled trials with patient-centred outcomes in the ED-setting are required to definitively establish which nerve block is most effective.
