PENG Block: Continuous Infusion vs. Programmed Intermittent Bolus in Neck of Femur Fracture

NCT07046052 | Recruiting

• 1 other identifier: PIB PENG RCT ECM5(3)5/3/2024
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

Pericapsular Nerve Group Block (PENG) is an effective regional anaesthesia modality in providing analgesia following neck of femur fracture. Continuous PENG techniques, using indwelling catheters and infusions of local anaesthetic, facilitate the continuation of analgesia for a number of days following hip fracture surgery. It is unclear from the published literature whether an optimal strategy of local anaesthetic delivery has been characterized. Similar doses of local anaesthetic agents can be administered by either continuous infusion or timed intermittent bolus. It is unclear whether one dosing strategy is superior to the other in the context of hip fracture analgesia. The study aims to evaluate the clinical efficacy of both dosing strategies in patients undergoing hip fracture surgery.

Conditions

Hip Fracture; Analgesia Post Fracture

Keywords

hip fracture; regional anaesthesia; analgesia; peng block; continuous infusion; programmed intermittent bolus; randomised controlled trial

Outcome Measures

Primary Outcomes (1)

• Numeric Rating Pain Scale (NRS 0-10)

  Patients will be invited to rate their post operative pain at rest and on movement on a 0-10 scale; where 0 is no pain and 10 is worst imaginable pain.

  48 Hours Post-operatively

Secondary Outcomes (2)

• Numeric Rating Pain Scale (NRS 0-10)

  1, 2, 4, 24 hours postoperatively

• Quality of Recovery 15 (QOR15)

  48 hours postoperatively

Study Arms (2)

Continuous PENG Infusion

ACTIVE COMPARATOR

Participants will be randomly assigned to this arm and will receive a continuous infusion of levobupivacaine.

Other: continuous infusion of levobupivacaine

Programmed Intermittent Bolus PENG

EXPERIMENTAL

Participants will be randomly assigned to this arm and will receive a timed pre-set bolus dose of levobupivacaine.

Other: Programmed Intermittent Bolus of Levobupivacaine

Interventions

continuous infusion of levobupivacaine OTHER

Participants in this arm will receive a continuous infusion of levobupivacaine via a regional anaesthesia catheter placed in the PENG fascial space. The total dose over 24 hours will be equivalent in both arms of the study.

Continuous PENG Infusion

Programmed Intermittent Bolus of Levobupivacaine OTHER

Participants in this arm will receive a timed pre-set bolus dose of levobupivacaine via a regional anaesthesia catheter placed in the PENG fascial space. The total dose over 24 hours will be equivalent in both groups.

Programmed Intermittent Bolus PENG

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• English-speaking
• over the age of 18 years
• hemiarthroplasty for fractured neck of femur
• able to provide written consent.

You may not qualify if:

• under 50kg body weight.
• unable to provide consent due to incapacity
• pregnant women
• vulnerable adults under state guardianship
• Patients with pre-existing chronic pain disorders or with a history of long-term opioid use
• those with contraindications to a peripheral nerve block such as local site infection, allergy to local anaesthetic or those who are coagulopathic

Sponsors & Collaborators

• University College Cork: lead

Study Sites (1)

Cork University Hospital

Cork, Cork, P85 FR62, Ireland

RECRUITING

Related Publications (12)

• Zheng J, Pan D, Zheng B, Ruan X. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Reg Anesth Pain Med. 2022 Mar;47(3):155-160. doi: 10.1136/rapm-2021-103228. Epub 2021 Dec 6.

  PMID: 34873023 BACKGROUND

• Lin X, Liu CW, Goh QY, Sim EY, Chan SKT, Lim ZW, Chan DXH. Pericapsular nerve group (PENG) block for early pain management of elderly patients with hip fracture: a single-center double-blind randomized controlled trial. Reg Anesth Pain Med. 2023 Nov;48(11):535-539. doi: 10.1136/rapm-2022-104117. Epub 2023 Apr 13.

  PMID: 37055189 BACKGROUND

• Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013 Jun;118(6):1332-40. doi: 10.1097/ALN.0b013e318289b84b.

  PMID: 23411725 BACKGROUND

• Yang L, Huang X, Cui Y, Xiao Y, Zhao X, Xu J. Combined Programmed Intermittent Bolus Infusion With Continuous Infusion for the Thoracic Paravertebral Block in Patients Undergoing Thoracoscopic Surgery: A Prospective, Randomized, and Double-blinded Study. Clin J Pain. 2022 Jun 1;38(6):410-417. doi: 10.1097/AJP.0000000000001037.

  PMID: 35442613 BACKGROUND

• Chen L, Wu Y, Cai Y, Ye Y, Li L, Xia Y, Papadimos TJ, Xu X, Wang Q. Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial. Reg Anesth Pain Med. 2019 Feb;44(2):240-245. doi: 10.1136/rapm-2018-000031. Epub 2019 Jan 5.

  PMID: 30700619 BACKGROUND

• Law WZW, Sara RA, Cameron AJD, Lightfoot NJ. Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta-analysis. Anaesthesia. 2020 Mar;75(3):395-405. doi: 10.1111/anae.14864. Epub 2019 Oct 14.

  PMID: 31612480 BACKGROUND

• Jagannathan R, Niesen AD, D'Souza RS, Johnson RL. Intermittent bolus versus continuous infusion techniques for local anesthetic delivery in peripheral and truncal nerve analgesia: the current state of evidence. Reg Anesth Pain Med. 2019 Apr;44(4):447-451. doi: 10.1136/rapm-2018-100082. Epub 2019 Feb 3.

  PMID: 30914472 BACKGROUND

• Duan L, Zhang L, Shi CG, Huang LG, Ao H, Wang ZP, Deng Y, Sun ML. Comparison of continuous pericapsular nerve group (PENG) block versus continuous fascia iliaca compartment block on pain management and quadriceps muscle strength after total hip arthroplasty: a prospective, randomized controlled study. BMC Anesthesiol. 2023 Jul 11;23(1):233. doi: 10.1186/s12871-023-02190-1.

  PMID: 37434138 BACKGROUND

• Senthil KS, Kumar P, Ramakrishnan L. Comparison of Pericapsular Nerve Group Block versus Fascia Iliaca Compartment Block as Postoperative Pain Management in Hip Fracture Surgeries. Anesth Essays Res. 2021 Oct-Dec;15(4):352-356. doi: 10.4103/aer.aer_119_21. Epub 2022 Mar 1.

  PMID: 35422548 BACKGROUND

• Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018 Feb;43(2):186-192. doi: 10.1097/AAP.0000000000000701.

  PMID: 29140962 BACKGROUND

• Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847.

  PMID: 30063657 BACKGROUND

• Butcher NJ, Monsour A, Mew EJ, Chan AW, Moher D, Mayo-Wilson E, Terwee CB, Chee-A-Tow A, Baba A, Gavin F, Grimshaw JM, Kelly LE, Saeed L, Thabane L, Askie L, Smith M, Farid-Kapadia M, Williamson PR, Szatmari P, Tugwell P, Golub RM, Monga S, Vohra S, Marlin S, Ungar WJ, Offringa M. Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension. JAMA. 2022 Dec 20;328(23):2345-2356. doi: 10.1001/jama.2022.21243.

  PMID: 36512367 BACKGROUND

MeSH Terms

Conditions

Hip Fractures; Agnosia

Condition Hierarchy (Ancestors)

Femoral Fractures; Fractures, Bone; Wounds and Injuries; Hip Injuries; Leg Injuries; Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Benjamin P Atterton, MBChB FRCA

  Cork University Hospital & University College Cork

  STUDY DIRECTOR

Central Study Contacts

Brian D O'Donnell, MBBChBAO MSc FCARCSI MD

CONTACT

+353872780225; briodnl@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Consultant Anaesthesiologist

Study Record Dates

• First Submitted: June 22, 2025
• First Posted: July 1, 2025
• Study Start: March 28, 2024
• Primary Completion: January 7, 2026
• Study Completion: January 7, 2026
• Last Updated: July 1, 2025

Record last verified: 2025-06

Locations

IE (1)