Comparison between femoral nerve block and pericapsular nerve group block as preemptive analgesia in geriatric intertrochanteric fractures: A prospective randomised controlled clinical trial.

Purpose: Regional blocks such as femoral nerve block (FNB) and Pericapsular nerve group (PENG) block are frequently used for postoperative pain relief in fractures around the hip joint. This study compares the analgesic efficacy of PENG block with FNB in the management of intertrochanteric fractures.

Methods: This randomised controlled clinical trial included patients aged 65-80 years with intertrochanteric fractures who were planned for closed reduction and cephalomedullary nailing. The patients were randomised into two groups: Group 1 (n = 40) received FNB, while Group 2 (n = 40) received PENG block preoperatively. The outcome measures were postoperative VAS score, total opioid consumption, quadriceps power, and duration of mobilisation.

Results: There was a significant reduction in postoperative pain in both groups. A comparison between the FNB and PENG blocks showed no significant difference in VAS scores at 6, 12, 18, 24, 36, and 48 h. The PENG group had better quadriceps strength preservation at 12 h (p < 0.05), with no significant difference between the two groups at 60 h. The total opioid consumption in the first 48 h was similar in both groups (8.03 Morphine milliequivalents (MME) in PENG and 7.07 MME in the FNB group, p-value >0.05).

Conclusion: PENG block and FNB are equally effective in pain relief and in reducing opioid requirements in elderly patients with intertrochanteric fractures. However, the PENG group showed better preservation of quadriceps strength at 12 h.