Effect of Preoperative PENG Block on Spinal Anesthesia Positioning and Postoperative Analgesia in Hip Fracture Surgery

NCT07194356 | Completed

• 2 other identifiers: KLKSH-ANES-PENG-0012023/514/261/14
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Hip fractures are among the most common orthopedic traumas, particularly in elderly patients, and are usually associated with significant pain during positioning for spinal anesthesia. Adequate pain control during positioning can improve patient comfort and facilitate successful administration of anesthesia. The pericapsular nerve group (PENG) block has recently been introduced as a regional anesthesia technique that targets articular branches of the femoral, obturator, and accessory obturator nerves, and has been proposed as a method to reduce pain related to hip fracture positioning. This study is designed to compare the efficacy of preoperative PENG block versus no block in patients undergoing proximal femoral nailing surgery under spinal anesthesia. The primary objective is to assess its effect on positioning pain using visual analog scale (VAS) scores. Secondary objectives include evaluating its impact on postoperative analgesic consumption, time to first rescue analgesic, and potential side effects.

Conditions

Hip Fractures (ICD-10 72.01-72.2); Postoperative Pain Management After Total Hip Arthroplasty; Elderly Patients; Regional Anesthesia

Keywords

PENG Block; Pericapsular Nerve Group Block; Hip Surgery; Geriatric Anesthesia; Analgesia; Visual Analog Scale; Tramadol; Ultrasound-Guided Block; Positioning Pain; Peripheral Nerve Block

Outcome Measures

Primary Outcomes (1)

• Pain intensity during positioning for spinal anesthesia

  Pain scores were recorded using the Visual Analog Scale (VAS; 0-10 cm, where 0 = no pain and 10 = worst pain imaginable) during positioning for spinal anesthesia prior to hip fracture surgery.

  During spinal anesthesia positioning (within 15 minutes preoperatively)

Secondary Outcomes (4)

• Postoperative VAS scores

  0-24 hours after surgery

• Cumulative tramadol requirement in the first 24 hours

  0-24 hours after surgery

• Time to first request for rescue analgesia

  0-24 hours after surgery

• Incidence of adverse events related to anesthesia

  Intraoperative to 24 hours postoperatively

Study Arms (2)

PENG Block Group

EXPERIMENTAL

Patients in this group received an ultrasound-guided Pericapsular Nerve Group (PENG) block prior to spinal anesthesia for hip fracture surgery. The block was performed with local anesthetic injection under ultrasound guidance, targeting the articular branches innervating the anterior hip capsule.

Procedure: Pericapsular nerve group (PENG) block

Control Group

ACTIVE COMPARATOR

Patients in this group did not receive a preoperative nerve block. They underwent spinal anesthesia directly for hip fracture surgery without prior intervention. Pain during positioning and postoperative analgesic requirements were evaluated in comparison to the PENG block group.

Procedure: Standard Spinal Anesthesia (Control)

Interventions

Pericapsular nerve group (PENG) block PROCEDURE

A single-shot PENG block was administered preoperatively using ultrasound guidance. The block was performed with the patient in the supine position, and 20 mL of local anesthetic (0.25% bupivacaine) was injected between the psoas tendon and the superior pubic ramus to achieve analgesia of the anterior hip capsule.

PENG Block Group

Standard Spinal Anesthesia (Control) PROCEDURE

Patients in this arm were managed according to standard care protocols for spinal anesthesia in hip fracture surgery. No preoperative regional block was performed. Pain scores and postoperative tramadol use were measured for comparison with the experimental arm.

Control Group

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged 18 to 90 years
• ASA (American Society of Anesthesiologists) physical status classification I-III
• Scheduled for proximal femoral nailing due to hip fracture
• Able to provide informed consent (or consent provided by a legal representative)
• Willingness to comply with study procedures and follow-up assessments

You may not qualify if:

• \- ASA physical status classification IV or V
• Refusal to provide informed consent
• Coagulopathy or current use of anticoagulant therapy contraindicating neuraxial block
• Local infection at the injection site
• Known allergy or hypersensitivity to local anesthetic agents
• Cognitive impairment or inability to cooperate with study procedures
• Severe psychiatric illness preventing reliable pain assessment
• Previous surgery or deformity of the hip interfering with block performance
• Pregnancy or lactation

Sponsors & Collaborators

• Dr. Lutfi Kirdar Kartal Training and Research Hospital: lead

Study Sites (1)

Facility Name: Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences

Istanbul, 34890, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Hip Fractures; Agnosia

Interventions

Dental Occlusion

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

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena

Study Officials

• Gulcan Gul, M.D.

  Department of Anesthesiology and Reanimation, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul, Turkey

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Participants and care providers were not blinded due to the nature of the intervention. However, the outcome assessor who recorded VAS scores and postoperative analgesic consumption was blinded to group assignment to reduce potential bias.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Specialist in Anesthesiology and Reanimation

Model Details: A randomized, parallel-group, controlled trial evaluating the effectiveness of PENG block versus no block in patients undergoing hip fracture surgery under spinal anesthesia.

Study Record Dates

• First Submitted: September 10, 2025
• First Posted: September 26, 2025
• Study Start: December 1, 2023
• Primary Completion: March 31, 2024
• Study Completion: May 31, 2024
• Last Updated: September 26, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)