PENG vs FICB Anesthesia for Hip Fracture

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Virginia

Disqualifiers: Refusal, Hemodynamic instability, Allergy, others

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

Compensation: Varies

Number of Visits: 1

Duration: 6 hours

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two types of anesthesia to manage pain in people with hip fractures. It compares the Pericapsular Nerve Group (PENG) block and the Fascia Iliaca Compartment Block (FICB) to determine which provides better pain control in the emergency department. Individuals with a fracture in the upper part of the thigh bone may qualify for this trial. As an unphased trial, it offers participants the chance to contribute to important research that could enhance pain management options for future patients.

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 prior data suggests that these anesthesia techniques are safe for hip fracture patients?

Research shows that both the PENG block and FICB are safe for managing pain in people with hip fractures.

Studies have found the PENG block effective and safe, with no major safety issues for patients undergoing hip fracture surgery. This method helps manage hip pain and can be used in emergency rooms.

Similarly, the FICB has been well-researched and proven safe for pain relief in hip fracture patients. Reports consistently show no complications from its use, and many reviews highlight its effectiveness in reducing pain before surgery.

Both treatments have strong safety records based on existing studies, making them well-tolerated options for those considering joining clinical trials for hip fracture pain management. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these anesthesia techniques because they promise more targeted pain relief for hip fracture patients. The PENG block focuses on numbing specific nerves linked directly to hip pain, potentially offering better pain control with fewer side effects compared to traditional methods like general anesthesia or systemic pain medication. The FICB also provides localized pain relief, but through a different nerve block technique, which might be easier to administer and just as effective. These techniques could improve patient comfort and recovery, making them an appealing option for both patients and healthcare providers.

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

This trial will compare the effectiveness of the Pericapsular Nerve Group (PENG) block and the Fascia Iliaca Compartment Block (FICB) for patients with hip fractures. Studies have shown that the PENG block effectively reduces pain after hip surgery, aids in positioning during anesthesia, and lowers the need for opioids, which are strong painkillers with many side effects. Research indicates that the FICB also provides significant pain relief within a few hours and reduces opioid use for up to two days. Both treatments have successfully eased hip fracture pain and minimized opioid use, making them promising options for managing pain in these situations. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

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.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• FICB
• PENG

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.

How Is the Trial Designed?

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 European Union, United States, Canada for the following indications:

Approved in European Union as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures and hip surgery

Approved in United States as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures and hip surgery

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+

Published Research Related to This Trial

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 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]

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]

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]

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]

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]

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 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 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]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39463554/

A Systematic Review and Meta-Analysis of Randomized ... In studies involving total hip arthroplasty, s-FICB was associated with a significant reduction in post-operative opioid consumption at 24 and ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9016604/

Effects of Perioperative Fascia Iliaca Compartment Block ... The results of the study revealed that FICB has a more significant effect in relieving pain, and reduces occurrence of adverse events. FICB can ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0735675721007774

Fascia iliaca block for hip fractures in the emergency ... Patients receiving FICB had significant better pain relief at rest at 2–4 h with mean difference of 1.59 (95% CI, 0.59–2.59, p = 0.002) with I2 = 96%. However, ...

4. journals.lww.com journals.lww.com/md-journal/fulltext/2019/07120/the_efficacy_of_fascia_iliaca_compartment_block.11.aspx

The efficacy of fascia iliaca compartment block for pain... ... We identified VAS after hip fracture as outcomes, results shown that FICB has a beneficial role in reducing pain intensity up to 48 h. There was no significant ...

5. nature.com nature.com/articles/s41598-025-18616-4

Median effective concentration of ropivacaine for ... Previous studies have shown that administration of 0.5% ropivacaine significantly relieves pain in elderly hip fracture patients for 36 to 48 h.

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/34660043/

Fascia Iliaca Compartment Block for Hip Fractures There were no complications associated with the administration of FICB to patients with hip fractures. ... This study showed that clinical ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S0007091218300412

Systematic review of the effects of fascia iliaca ... Conclusions. Fascia iliaca compartment block is an effective and relatively safe supplement in the preoperative pain management of hip fracture patients.

8. surgicoll.scholasticahq.com surgicoll.scholasticahq.com/article/131743-frequency-of-fascia-iliaca-block-administration-in-elderly-patients-with-hip-fractures-a-retrospective-chart-review

Frequency of Fascia Iliaca Block Administration in Elderly ... The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch ...

9. frontiersin.org frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1611618/full

a systematic review and meta-analysis of randomized trials ... Conclusion: Compared to intravenous analgesia, UG-FICB provides superior, sustained pain relief with fewer opioid-related complications and ...