A study to compare ultrasound guided pericapsular nerve group block versus intravenous fentanyl, for positioning during spinal anaesthesia in patient undergoing proximal femur fracture surgeries

Background: Spinal anesthesia is the preferred method for fixing a femur fracture, but severe pain can hinder optimal patient positioning for this procedure. Both intravenous (IV) fentanyl and pericapsular nerve group (PENG) block are frequently employed to alleviate pain during positioning. However, studies have shown inconsistent findings regarding whether PENG block is more effective than IV fentanyl. In this study, we compared the analgesic effects of IV fentanyl and PENG block before placing the patients for central neuraxial block for femur fracture surgery.

Methods: 60 patients scheduled for femur fracture surgery under spinal anesthesia were enrolled. Patients were randomized into two groups using a computer-generated random numbers, the PENG block and the IV fentanyl (FENT) groups. In the PENG block group, patients received a 20ml injection of 0.5% bupivacaine. In the FENT group, patients received IV fentanyl 1 µg/kg, administered 5 minutes before positioning for surgery. Pain scores were assessed both before and during the positioning phase and were recorded for comparison between the two groups. Continuous variables were analyzed with the unpaired t test. Categorical variables were analyzed with the Chi-Square Test and Fisher Exact Test. Statistical significance was taken as P < 0.05. The data was analyzed using SPSS version 29

Results: VAS score during positioning between PENG group versus FENT group(P=0.0029), Quality of patient positioning between PENG group and FENT group (P=0.0024), patient satisfaction status between PENG group (yes=96.67%, no=3.33%) and FENT group (yes=76.67%, no=23.33%)(P=0.0284), time to perform subarachnoid block between PENG group and FENT group(P=<0.0001), time of first postoperative analgesic need between PENG group and FENT group (P=<0.0001)

Conclusion: The peri-capsular nerve group block provides superior pain compared to intravenous fentanyl for subarachnoid block in patients undergoing surgery for femur fractures.