Point-of-care ultrasound-guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report.

Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard-volume point-of-care ultrasound-guided pericapsular nerve group (PENG) block performed in the emergency department. The standard-volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.

Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study.

OBJECTIVES: The pericapsular nerve group (PENG) block was first described for analgesia of hip fracture in 2018. We hypothesised that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the ED. METHODS: This was an observational study of routine care. Consecutive patients receiving regional anaesthesia for hip fracture at a single ED were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 min after administration. Maximal reduction in pain scores within 60 min were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 h after regional anaesthesia and adverse events over the duration of admission. RESULTS: There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 fascia iliaca compartment blocks, 14 femoral nerve blocks) and 19 received a PENG block. Inexperienced providers were able to successfully perform the PENG block. There was no difference in maximum pain score reduction between the groups. There was no difference in adverse effects between groups. Opioid use was similar between the groups. More patients were opioid-free after a PENG block. CONCLUSIONS: The present study demonstrated that the PENG block can be provided safely and effectively to patients with hip fracture in the ED. On the basis of this pilot study, a larger randomised controlled study should now be designed.