PENG vs FICB Anesthesia for Hip Fracture

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Virginia

Disqualifiers: Refusal, Hemodynamic instability, Allergy, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial compares two methods of numbing the hip area in elderly patients with hip fractures. These methods aim to reduce pain and may be more effective and safer than traditional pain medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment PENG block for hip fracture?

Research suggests that both the PENG block and the FICB are effective in providing pain relief for hip fractures, with some studies indicating that the PENG block may offer better pain control and facilitate early rehabilitation after surgery. ^{1 2 3 4 5}

Is PENG or FICB anesthesia safe for humans?

The studies reviewed focus on comparing the effectiveness of PENG and FICB blocks for pain relief in hip surgeries, but they do not report any specific safety concerns, suggesting these methods are generally considered safe for use in humans. ^{1 2 3 4 5}

How does the PENG vs FICB treatment for hip fracture differ from other treatments?

The PENG (Pericapsular Nerve Group) Block and FICB (Fascia Iliaca Compartment Block) are unique because they are nerve block techniques used to manage pain in hip fractures, offering a less invasive alternative to traditional surgical methods. These blocks target specific nerves to provide pain relief, potentially reducing the need for systemic pain medications and their associated side effects. ^{6 7 8 9 10}

Research Team

Eligibility Criteria

This trial is for emergency department patients with hip fractures, specifically femoral neck or intertrochanteric fractures. Participants must consent to the procedure and not have allergies to local anesthetics. Those with severe injuries causing instability, serious unstable medical conditions, or hemodynamic instability cannot join.

Inclusion Criteria

I have a broken hip bone.

Exclusion Criteria

Allergy to local anesthetics

My blood pressure and heart rate are stable.

I do not agree to participate in the study.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either the PENG block or FICB for pain control in the emergency department

6 hours

1 visit (in-person)

Follow-up

Participants are monitored for pain control and opioid use until surgery or up to 24 hours

24 hours

Treatment Details

Interventions

• FICB (Procedure)
• PENG (Procedure)

Trial Overview The study compares two regional anesthesia techniques: PENG (Pericapsular Nerve Group) block and FICB (Fascia Iliaca Compartment Block), in terms of pain control effectiveness for hip fracture patients. The hypothesis suggests that PENG might be more effective based on prior studies.

Participant Groups

Group I: PENG Active Control 1 Intervention

Patients with hip fracture randomized to receive PENG block

Group II: FICB Active Control 1 Intervention

Patients with hip fracture randomized to received FICB

FICB is already approved in Canada for the following indications:

Approved in Canada as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures and hip surgery

Who Is Running the Clinical Trial?

University of Virginia

Lead Sponsor

Trials

802

Recruited

1,342,000+

James E. Ryan

University of Virginia

Chief Executive Officer since 2018

J.D. from Harvard Law School

Nikki Hastings

University of Virginia

Chief Medical Officer since 2018

Ph.D. in Biomedical Engineering from University of Virginia

Findings from Research

In a study of 66 hip-fracture patients, the pericapsular nerve group (PENG) block provided better pain relief and facilitated easier positioning for spinal anesthesia compared to the supra-inguinal fascia-iliaca compartment block (S-FICB).

Both PENG and S-FICB significantly reduced pain scores after the block, but the PENG group showed superior ease of positioning and similar overall analgesic effectiveness within the first 24 hours.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial. Jadon, A., Mohsin, K., Sahoo, RK., et al.[2022]

In a study of 384 patients undergoing hip surgery, the Pericapsular Nerve Group (PENG) block was found to significantly reduce static pain scores at 12 hours post-surgery and decrease opioid consumption in the first 24 hours compared to the Fascia Iliaca compartment (FI) block.

However, there were no significant differences in pain scores at 6 or 24 hours post-surgery or in the time to first analgesic rescue between the two techniques, indicating that while PENG may offer some immediate benefits, further research is needed to fully understand its advantages over FI block.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. Andrade, PP., Lombardi, RA., Marques, IR., et al.[2023]

The pericapsular nerve group (PENG) block significantly reduced pain scores and delayed the need for analgesics compared to the fascia iliaca compartment block (FICB) in patients with hip fractures, based on a randomized controlled trial involving 52 participants.

Patients receiving the PENG block consumed significantly less morphine in the first 24 hours post-surgery compared to those receiving the FICB, indicating that PENG may provide superior analgesia for hip fracture pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical trial. Mosaffa, F., Taheri, M., Manafi Rasi, A., et al.[2022]

In a review of six randomized controlled trials involving 258 patients, the pericapsular nerve group block (PENG) was found to significantly reduce opioid consumption compared to the fascia iliaca compartment block (FICB) after hip surgeries, suggesting better pain management with PENG.

However, there was no significant difference in pain scores at 6, 12, or 24 hours post-surgery between the two groups, indicating that while PENG may reduce the need for opioids, it does not necessarily lead to lower pain levels compared to FICB.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of pericapsular nerve group block vs. fascia iliaca compartment block for Hip surgeries: A systematic review and meta-analysis. Ying, H., Chen, L., Yin, D., et al.[2023]

In a study of 59 elderly patients undergoing hip fracture surgery, adding a pericapsular nerve group (PENG) block to a fascia iliaca compartment block (FICB) did not significantly improve pain relief or recovery outcomes compared to FICB alone.

Both groups experienced similar pain scores and recovery times, but the combined FICB + PENG block took significantly longer to perform, indicating that the additional procedure may not be worth the extra time if it does not enhance patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Analgesic effect of adding ultrasound-guided pericapsular nerve group block to suprainguinal fascia iliaca compartment block for hip fracture surgery: A prospective randomized controlled trial. Nuthep, L., Klanarong, S., Tangwiwat, S.[2023]

The non-fluoroscopic technique for supra-acetabular pin placement in traumatic pelvic fractures significantly reduced operative time (522 seconds vs. 211 seconds for fluoroscopic-assisted) while maintaining similar complication rates between the two methods.

Although the fluoroscopic-assisted group had a slightly higher infection rate (5% vs. 0%), both techniques demonstrated comparable safety, suggesting that the non-fluoroscopic method may be a more efficient option for this procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of supra-acetabular pin placement with and without fluoroscopic assisted: a prospective randomized controlled trial. Ruangsillapanan, N., Rattanakitkoson, T., Nimmankiatkul, S.[2023]

In a study of 17 patients with displaced acetabular fractures, anatomic reduction was successfully achieved in 83% of cases using various surgical approaches, including surgical hip dislocation and the Stoppa approach, with no instances of avascular necrosis reported.

Postoperative management included intensive mobilization and weight-bearing restrictions, which contributed to a low complication rate, with only three complications noted, indicating the safety and efficacy of the surgical techniques employed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach]. Tannast, M., Siebenrock, KA.[2022]

The proximal femoral nail anti-rotating (PFNA) technique is identified as the optimal surgical intervention for intertrochanteric fractures, showing significant reductions in blood loss compared to other methods like compression hip screw (CHS) and dynamic hip screw (DHS).

No significant differences in complications were found among the eight surgical procedures analyzed, indicating that while PFNA is more effective in reducing blood loss and improving hip function, it does not increase the risk of complications compared to other surgical options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials. Cheng, YX., Sheng, X.[2021]

The study compared percutaneous compression plating (PCCP) to standard gamma nail (GN) for treating intertrochanteric hip fractures in 133 patients, showing that PCCP resulted in significantly lower blood loss and reduced need for transfusions.

PCCP also had fewer implant-related complications and similar surgery times compared to GN, leading to overall lower surgical costs while achieving comparable healing outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Percutaneous compression plating versus gamma nail for the treatment of pertrochanteric hip fractures. Giancola, R., Antonini, G., Delle Rose, G., et al.[2021]

In a study of 28 children with severe cerebral palsy undergoing proximal femoral osteotomies, the Pediatric locking compression plate (LCP) Hip Plate system showed a lower consolidation rate at 6 weeks post-surgery (19.6%) compared to a historical group using a conventional blade plate (91.1%), although both methods achieved complete consolidation by 12 weeks.

Despite the LCP system having a longer average surgery time and more blood loss, it allowed for immediate full weight bearing in some patients (10.7%), indicating potential benefits in post-operative recovery, although the recommendation is to wait at least 6 months for plate removal.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The pediatric LCP hip plate for fixation of proximal femoral osteotomy in cerebral palsy and severe osteoporosis. Rutz, E., Brunner, R.[2022]

References

1. India pubmed.ncbi.nlm.nih.gov

Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial. [2022]

2. Brazil pubmed.ncbi.nlm.nih.gov

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. [2023]

3. France pubmed.ncbi.nlm.nih.gov

Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical trial. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Efficacy of pericapsular nerve group block vs. fascia iliaca compartment block for Hip surgeries: A systematic review and meta-analysis. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

The Analgesic effect of adding ultrasound-guided pericapsular nerve group block to suprainguinal fascia iliaca compartment block for hip fracture surgery: A prospective randomized controlled trial. [2023]

6. France pubmed.ncbi.nlm.nih.gov

Outcomes of supra-acetabular pin placement with and without fluoroscopic assisted: a prospective randomized controlled trial. [2023]

7. Germany pubmed.ncbi.nlm.nih.gov

[Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach]. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials. [2021]

9. India pubmed.ncbi.nlm.nih.gov

Percutaneous compression plating versus gamma nail for the treatment of pertrochanteric hip fractures. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

The pediatric LCP hip plate for fixation of proximal femoral osteotomy in cerebral palsy and severe osteoporosis. [2022]