Comparison of Femoral Nerve Block and Combined PENG Plus Femoral Nerve Block in Geriatric Hip Surgery

NCT07350044 | Recruiting

• 1 other identifier: TABED 1-26-2268
• Study Type: interventional
• Target: 68
• Locations: 1 country
• Sites: 1

Brief Summary

Hip fracture surgery in geriatric patients is frequently associated with severe perioperative pain, which may complicate positioning for spinal anesthesia and increase perioperative opioid requirements. Regional analgesic techniques are commonly used to improve patient comfort and reduce opioid consumption in this vulnerable population. The femoral nerve block is a well-established method for analgesia in hip surgery, while the pericapsular nerve group (PENG) block has emerged as a novel technique targeting articular branches of the hip joint with potential advantages in pain control. This prospective randomized controlled trial aims to compare the analgesic efficacy of femoral nerve block alone versus a combined pericapsular nerve group (PENG) plus femoral nerve block in geriatric patients undergoing hip fracture surgery under spinal anesthesia. The primary outcomes include perioperative pain intensity, opioid consumption within the first 24 hours postoperatively, and the need for additional analgesia during positioning for spinal anesthesia. Secondary outcomes include spinal anesthesia procedure duration, time to sensory block onset, time to first postoperative opioid requirement, and perioperative hemodynamic parameters. The results of this study are expected to clarify whether the addition of the PENG block to femoral nerve block provides superior perioperative analgesia and improved patient comfort compared with femoral nerve block alone in geriatric hip fracture surgery.

Conditions

PENG Block; Hip Fracture Surgeries

Keywords

PENG block; Femoral block; Hip Fracture Surgeries; Pain; Opioid

Outcome Measures

Primary Outcomes (1)

• Pain Score During Positioning for Spinal Anesthesia

  To compare pain intensity during patient positioning for spinal anesthesia between the Femoral Nerve Block group and the combined Pericapsular Nerve Group (PENG) + Femoral Nerve Block group. Pain will be assessed using the Visual Analog Scale (VAS) at the time of lateral decubitus positioning for spinal anesthesia. The need for additional intravenous fentanyl during positioning will also be recorded.

  Periprocedural: from initiation of lateral decubitus positioning for spinal anesthesia to completion of the spinal anesthetic procedure (needle withdrawal following intrathecal injection).

Secondary Outcomes (3)

• Postoperative Pain Scores Within the First 24 Hours

  Within the first 24 hours postoperatively

• Total Opioid Consumption Within the First 24 Hours

  Within the first 24 hours postoperatively.

• Hemodynamic Stability During Perioperative Period

  From block application to 24 hours postoperatively

Study Arms (2)

Femoral Nerve Block

EXPERIMENTAL

Participants will receive a preoperative ultrasound-guided femoral nerve block performed approximately 30 minutes before surgery.

Procedure: Femoral Nerve Block

PENG Block + Femoral Nerve Block

EXPERIMENTAL

Participants will receive a combination of preoperative ultrasound-guided pericapsular nerve group (PENG) block and femoral nerve block performed approximately 30 minutes before surgery.

Procedure: Pericapsular nerve group (PENG) block plus femoral nerve block

Interventions

Pericapsular nerve group (PENG) block plus femoral nerve block PROCEDURE

Combination of ultrasound-guided pericapsular nerve group (PENG) block and femoral nerve block performed preoperatively approximately 30 minutes before surgery using 20 mL of 0.25% bupivacaine for each block for perioperative analgesia.

PENG Block + Femoral Nerve Block

Femoral Nerve Block PROCEDURE

Ultrasound-guided femoral nerve block performed preoperatively approximately 30 minutes before surgery using 20 mL of 0.25% bupivacaine for perioperative analgesia.

Femoral Nerve Block

Eligibility Criteria

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

You may qualify if:

• Age 65 years and older,
• Patients scheduled for surgery due to hip fracture,
• American Society of Anesthesiologists (ASA) physical status I-III,
• Body mass index between 18 and 40 kg/m²,
• Preoperative fasting duration of approximately 8 hours,
• Planned spinal anesthesia,
• Ability to provide written informed consent.

You may not qualify if:

• Age below 65 years,
• Refusal to participate in the study,
• Severe cognitive impairment, dementia, or Alzheimer's disease,
• ASA physical status IV or higher,
• Body mass index \> 40 kg/m²,
• Failed spinal anesthesia or conversion to general anesthesia,
• Revision hip surgery,
• Multiple trauma patients,
• Old hip fractures (\>3 weeks),
• Active malignancy receiving chemotherapy or radiotherapy,
• Active infection requiring antibiotic treatment (except prophylaxis),
• Contraindications to regional anesthesia techniques,
• Chronic steroid or immunosuppressive therapy,
• Use of anti-inflammatory drugs,
• Non-fasted patients,

Sponsors & Collaborators

• Ankara City Hospital Bilkent: lead

Study Sites (1)

Ankara Bilkent City Hospital

Ankara, Turkey (Türkiye)

RECRUITING

Related Publications (3)

• 39514540

  BACKGROUND

• 38073453

  BACKGROUND

• PMID: 38073453

  BACKGROUND

MeSH Terms

Conditions

Pain

Interventions

Dental Occlusion

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

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

Central Study Contacts

Sündüz İlayda Yıldız Akça

CONTACT

+905076111649; sunduzilayda@hotmail.com

Semih Başkan

CONTACT

+905326030675

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, Clinical Professor, Anesthesiology and Reanimation, Principal İnvestigator

Model Details: Participants will be randomly assigned in parallel to one of two groups. One group will receive a preoperative femoral nerve block, while the other group will receive a combination of preoperative pericapsular nerve group (PENG) block and femoral nerve block. All interventions will be performed before surgery, and participants will be followed for 24 hours postoperatively.

Study Record Dates

• First Submitted: January 5, 2026
• First Posted: January 20, 2026
• Study Start: January 15, 2026
• Primary Completion (Estimated): May 15, 2026
• Study Completion (Estimated): June 1, 2026
• Last Updated: March 25, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)