PENG vs Femoral Block for Hip Fracture

Overseen By Mark Abdelmassih, B.S.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Weill Medical College of Cornell University

Must not be taking: Opioids

Disqualifiers: Altered mental status, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 4 weeks

352 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two pain relief methods, the PENG block and the femoral block, for individuals with hip fractures. Researchers aim to determine which block more effectively manages pain, focusing on various fracture types. Participants will receive one of these treatments based on a randomized schedule. This study suits those diagnosed with a hip fracture and willing to receive an analgesic block. As an unphased trial, it offers participants the chance to contribute to valuable research that could enhance pain management for future patients with hip fractures.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you have a chronic pain diagnosis and are on preoperative opioids, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that both the PENG block and the femoral block safely manage pain in people with hip fractures.

For the PENG block, studies indicate it effectively reduces pain without major side effects. Patients reported less pain 12, 24, and 48 hours after treatment. Evidence also suggests it causes less muscle weakness compared to other pain relief methods.

The femoral block is well-tolerated. Research suggests it is a safe alternative to opioids for pain relief, managing pain effectively without major side effects.

Both treatments have strong evidence supporting their safety for pain relief in hip fracture patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they offer new approaches to pain management for hip fractures. The PENG Block targets specific nerves associated with hip pain more directly than traditional methods, potentially leading to better pain relief and fewer side effects. On the other hand, the Femoral Block is a well-known technique but is being fine-tuned to maximize effectiveness and safety. Both methods aim to improve patient comfort and recovery, offering promising alternatives to current pain management options like systemic opioids or epidural anesthesia.

What evidence suggests that this trial's treatments could be effective for hip fracture pain?

This trial will compare the effectiveness of the femoral block and the PENG (Pericapsular Nerve Group) block for managing pain from hip fractures. Studies have shown that the femoral block safely and effectively reduces pain and limits the need for opioid painkillers, aiding early pain relief and speeding up recovery after surgery. Meanwhile, research indicates that the PENG block controls pain more effectively than other methods and significantly reduces the need for opioids, which can cause unwanted side effects. Both treatments are promising, but the PENG block might offer better overall pain management and fewer complications. ^{1 3 6 7 8}

Who Is on the Research Team?

Tiffany Tedore, MD

Principal Investigator

Weill Medical College of Cornell University

Are You a Good Fit for This Trial?

Adults aged 18 or older with a diagnosed hip fracture, who consent to pain management via peripheral block and have an ASA Classification of 1-4 (a measure of fitness for anesthesia), can participate. Specific details about the fracture location must be confirmed by radiologic assessment.

Inclusion Criteria

My health is classified between low to high risk for surgery.

I am 18 years old or older.

I have a documented hip fracture with its location confirmed by an X-ray.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either a PENG or femoral block for hip fracture pain based on a randomized monthly schedule

4 weeks

1 visit (in-person) per block administration

Follow-up

Participants are monitored for pain score changes and opioid consumption for 24 hours post-block

24 hours

Sub-group Analysis

Analysis to determine differences in efficacy between intracapsular and extracapsular fractures

What Are the Treatments Tested in This Trial?

Interventions

• Femoral Block
• PENG Block

Trial Overview The study is comparing two types of nerve blocks for managing hip fracture pain: PENG (Pericapsular Nerve Group) block and femoral block. Participants will receive one type based on a randomized monthly schedule. The effectiveness in different fracture locations (intracapsular vs extracapsular) will also be analyzed.

How Is the Trial Designed?

Group I: PENG Block Administration Experimental Treatment 2 Interventions

Policy for the administration of the PENG block as per clinical guidelines to all subjects presenting to the hospital with a diagnosis of hip fracture and consenting to analgesic block

Group II: Femoral Block Administration Experimental Treatment 2 Interventions

Policy for the administration of the Femoral block as per clinical guidelines to all subjects presenting to the hospital with a diagnosis of hip fracture and consenting to analgesic block

Who Is Running the Clinical Trial?

Weill Medical College of Cornell University

Lead Sponsor

Trials

1,103

Recruited

1,157,000+

New York Presbyterian Hospital

Collaborator

Trials

77

Recruited

57,300+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5173407/

Regional Nerve Blocks Improve Pain and Functional ... Pain is universal, undertreated, and impedes recovery in hip fracture. This study compared outcomes for regional nerve blocks to standard analgesics ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT02450045

NCT02450045 | Pre-op Femoral Nerve Block for Hip Fracture Continuous preoperative femoral nerve blockade (CFNB) offers the potential benefit of reducing pain in these often frail patients well avoiding adverse outcomes ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0196064424000362

Peripheral Nerve Blocks in the Preoperative Management ... Compared with no block, preoperative peripheral nerve blocks for hip fractures appear to reduce pain 2 hours after block placement.

4. ceemjournal.org ceemjournal.org/m/journal/view.php?doi=10.15441/ceem.23.112

Femoral nerve blocks versus standard pain control for hip ... Our findings suggest that femoral nerve blocks are a safe and effective alternative to opioid use for pain management in patients with hip ...

5. thennt.com thennt.com/nnt/peripheral-nerve-block-hip-fracture/

Peripheral Nerve Block for Hip Fracture Outcomes summarized here included pain on movement 30 minutes after block placement, delirium within 30 days, time to mobilization after surgery, and chest ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT02450045

NCT02450045 | Pre-op Femoral Nerve Block for Hip Fracture Effective pain management can affect long-term outcomes: poorly managed pain is associated with delayed ambulation, pulmonary complications, and delayed ...

7. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0216337

Efficacy and safety of femoral nerve block for the positioning of ... FNB was an effective and safe strategy for the positioning of femur fracture patients for a spinal block, particularly patients who received SA in the sitting ...

8. mdpi.com mdpi.com/2077-0383/13/12/3457

Peripheral Nerve Blocks for Hip Fractures A systematic review found the loss-of-resistance-technique fascia iliaca compartment block to be an effective and safe tool for preoperative ...