Clin Exp Emerg Med.  2022 Sep;9(3):198-206. 10.15441/ceem.22.177.

“Diffusion of innovations”: a feasibility study on the pericapsular nerve group block in the emergency department for hip fractures

• Ramachandran A
• Montenegro M
• Singh M
• Dixon T
• Kayani W
• Liang T
• Yu N
• Reddy S
• Liveris A
• Manyapu M
• McEwan AA
• Nguyen VT
• Sonenthal NV
• Corbo J
• Friedman BW
• Sperling J
• Jones MP
• Halperin M

• KMID: 2534212
• DOI: http://doi.org/10.15441/ceem.22.177

Abstract

Objective
Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects. Through training, simulation, and supervision, we aim to determine whether it is feasible to perform the PENG block in the emergency department.
Methods
Phase 1 consisted of emergency physicians attending a workshop to demonstrate ultrasound proficiency, anatomical understanding, and procedural competency using a low-fidelity model. Phase 2 consisted of a prospective, observational, feasibility study of 10 patients with hip fractures. Pain scores, side effects, and opioid usage data were collected.
Results
The median pain score at time 0 (time of block) was 9 (interquartile range [IQR], 6.5–9). The median pain score at 30 minutes was 4 (IQR, 2.0–6.8) and 3.5 (IQR, 1.0–4.8) at 4 hours. All 10 patients required narcotics prior to the initiation of the PENG block with a median dosage of 6.25 morphine milligram equivalents (MME; IQR, 4.25–7.38 MME). After the PENG block, only 30% of the patients required further narcotics with a median dosage of 0 MME (IQR, 0–0.6 MME) until operative fixation.
Conclusion
In this feasibility study, PENG blocks were safely administered by trained emergency physicians under supervision. We demonstrated data suggesting a trend of pain relief and decreased opiate requirements, and further investigation is necessary to measure efficacy.

Keyword

Nerve block; Hip fractures; Hospital emergency service; Pain management; Interventional ultrasonography