Pericapsular Hip Block Guided by Ultrasonography in Elderly People with Hip Fracture in the Emergency Sector: Clinical Trial

Abstract

Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed.

Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block.

Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p < 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p < 0.05).

Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.

Keywords

analgesia - anesthesia, conduction - nerve block - pain - hip fractures - ultrasonography

Authors' Contribution:

The authors contributed individually and significantly in preparing this article: GMF: conception and design, collection, analysis and interpretation of data, article writing. MVP: conception and interpretation of data. EHM: conception and design. AISN: data acquisition. TRG: design and intellectual content review. LHSR: data interpretation. All authors read and approved the final version.

Work developed at the Department of Orthopedics and Traumatology, Hospital Municipal Dr. Alípio Corrêa Netto, and the Department of Pain Therapy, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.

Publication History

Received: 03 July 2023

Accepted: 25 August 2023

Article published online:
10 April 2024

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