PENG vs FIC Nerve Blocks for Hip Fracture Pain

Overseen By Antonios Likourezos, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Antonios Likourezos

Must not be taking: Opioids

Disqualifiers: Multi-system trauma, Pregnancy, Intoxication, others

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

Compensation: Varies

Number of Visits: 2

Duration: 1 day

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two methods to manage pain from hip fractures in the emergency department without heavily relying on opioids. It compares the PENG block, a newer technique targeting specific nerves around the hip, with the more established FIC block (Fascia Iliaca Compartment Block), both using the local anesthetic Bupivacaine. The goal is to determine if the PENG block is as effective as the FIC block in easing pain. Suitable participants have a hip fracture, experience significant pain (a pain score of 5 or higher), and can communicate their pain level. As an unphased trial, this study offers an opportunity to contribute to innovative pain management strategies without heavy opioid use.

Do I need to stop my current medications to join the trial?

The trial does not specify if you need to stop taking your current medications, but it does exclude patients who are on long-term systemic opioid analgesia.

What prior data suggests that these nerve block techniques are safe for treating hip fracture pain?

Previous studies have shown that the PENG block effectively relieves pain in patients with hip fractures and causes less thigh muscle weakness compared to other methods. One study found lower pain levels at 12, 24, and 48 hours after using the PENG block, indicating good pain control over time. This suggests that the PENG block is generally well-tolerated.

Research on the FIC block has shown it to be a safe and effective way to manage pain from hip fractures, providing consistent relief regardless of the doctor's experience. Another study confirmed its safety for emergency pain relief, especially in older patients.

Both the PENG and FIC blocks use bupivacaine, a common local anesthetic. While bupivacaine is widely used and generally safe, it can have side effects. However, studies have reported that both blocks provide effective pain relief with good safety profiles. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about comparing the PENG block and the FIC block for hip fracture pain because they offer different approaches to pain management. The PENG block targets the pericapsular nerve group, delivering Bupivacaine 0.50% directly to the hip area, potentially providing more localized and effective pain relief. On the other hand, the FIC block uses a larger volume of Bupivacaine 0.25% and targets the fascia iliaca compartment, which might offer broader pain coverage. Both methods are minimally invasive and could offer faster, more targeted pain relief compared to traditional systemic pain medications, reducing the need for opioids and their associated side effects.

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

This trial will compare the PENG block and the FIC block for managing hip fracture pain. Research has shown that the PENG block provides significant pain relief and reduces the need for opioids, cutting morphine use by 50-70%. It minimally affects muscle movement, helping to maintain mobility. Studies have found that the PENG block effectively reduces pain and aids recovery after a hip fracture. In contrast, the FIC block is a well-established method for managing hip fracture pain, reliably reducing pain in the first few hours after use. Both methods are considered safe and effective, but no direct comparison has determined which one is superior. Participants in this trial will receive either the PENG block or the FIC block to evaluate their effectiveness. ^{2 4 6 7 8}

Who Is on the Research Team?

Lawrence Haines, MD

Principal Investigator

Maimonides Medical Center

Are You a Good Fit for This Trial?

This trial is for adults over 18 with an isolated hip fracture and a pain score of 5 or more. It's not for those with multiple injuries, communication issues about pain, pregnancy, under 18 years old, intoxication, abnormal vital signs, long-term opioid use or allergy to certain local anesthetics.

Inclusion Criteria

I have a hip fracture near the top of my thigh bone.

My pain level is 5 or higher on a scale of 0 to 10 before getting a nerve block.

I am over 18 and need emergency medical care.

Exclusion Criteria

Allergy to amide local anesthetics

I cannot express how much pain I am in.

I am on long-term pain medication.

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 block or a FIC block for pain management in the ED

1 day

1 visit (in-person)

Immediate Follow-up

Participants' pain scores and motor function are assessed at 30 and 60 minutes post nerve block

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any adverse events and rescue medication usage after the nerve block

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• FIC Proceedure
• PENG Proceedure

Trial Overview

The study compares two types of nerve blocks in emergency department patients with hip fractures: PENG block using Bupivacaine (0.50%) and FIC block using Bupivacaine (0.25%). The goal is to see if PENG provides similar or better pain relief than FIC without opioids.

How Is the Trial Designed?

Group I: PENG Block Active Control 1 Intervention

Pericapsular Nerve Group (PENG) Block (20mL of Bupivacaine 0.50%)

Group II: Fascia Iliaca Compartment Active Control 1 Intervention

Fascial Iliaca block (FIC) (40mL of Bupivacaine 0.25%) for patients with hip fractures in the ED

FIC Proceedure is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures
• Pain management for orthopedic injuries

Approved in European Union as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures
• Pain management for orthopedic injuries

Approved in Canada as Fascia Iliaca Compartment Block for:

• Pain management for hip fractures
• Pain management for orthopedic injuries

Who Is Running the Clinical Trial?

Antonios Likourezos

Lead Sponsor

Trials

41

Recruited

8,600+

Published Research Related to This Trial

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 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 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 study involving 40 patients undergoing hip fracture surgeries, the pericapsular nerve group (PENG) block provided better postoperative pain relief as indicated by lower Visual Analog Pain scores compared to the fascia iliaca compartment block (FICB).

While both blocks showed similar durations of analgesia, the PENG block resulted in less motor impairment of the quadriceps femoris muscle, suggesting it offers effective sensory blockade with better preservation of motor function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Pericapsular Nerve Group Block versus Fascia Iliaca Compartment Block as Postoperative Pain Management in Hip Fracture Surgeries. Senthil, KS., Kumar, P., Ramakrishnan, L.[2022]

In a study involving 60 elderly patients with traumatic proximal femoral fractures, the Pericapsular Nerve Group (PENG) block did not show superior pain relief compared to the Fascia Iliaca block (FIB), with both achieving similar rates of analgesic success (53.3% for PENG vs 53.6% for FIB).

The study indicates that PENG block may not be a more effective option for pain management in this patient population, suggesting that FIB remains a viable alternative for treating hip trauma pain in the emergency room.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analgesic efficacy of Pericapsular Nerve Group (PENG) block compared with Fascia Iliaca Block (FIB) in the elderly patient with fracture of the proximal femur in the emergency room. A randomised controlled trial. Marrone, F., Graziano, G., Paventi, S., et al.[2023]

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]

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