ArticleJournal of anesthesia, analgesia and critical care2025
PENG block in elderly patients with hip fracture: less is more? A prospective observational monocentric study.
Article in Journal of anesthesia, analgesia and critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Best practices in the management of proximal femoral fractures in elderly patients on the ward: a narrative review.EFORT open reviews · 2026Review
- Precision and safety advantages of ultrasound-guided nerve blocks in geriatric anesthesia: current status and future prospects.Frontiers in medicine · 2025Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProximal femur fractures in the elderly are a common and serious condition with high morbidity and mortality. Effective postoperative pain control reduces complications, hospital stay, and opioid use. The PEricapsular Nerve Group (PENG) block is a regional anesthesia technique offering motor-sparing analgesia, facilitating spinal anesthesia and early rehabilitation. However, higher local anesthetic (LA) doses may increase the risk of systemic toxicity, particularly in frail, sarcopenic patients. This study evaluates the analgesic efficacy and safety of two ropivacaine concentrations (0.375% vs 0.25%) in PENG blocks.
methodsThis prospective observational monocentric study included 217 patients (aged 65-100) undergoing surgery for osteoporotic proximal femur fractures. Patients received a 20-mL PENG block with either 0.375% or 0.25% ropivacaine prior to spinal anesthesia. Postoperative analgesia included paracetamol and ketorolac, with intramuscular morphine available as rescue. The primary endpoint was the proportion of patients requiring morphine; secondary outcomes included time to first rescue dose. Statistical analyses included chi-square testing, Kaplan-Meier estimates, and non-inferiority analysis (Δ = 0.05).
resultsThe proportion of patients requiring rescue morphine was 23% in the 0.375% group and 25% in the 0.25% group (p = 0.87). Non-inferiority was demonstrated, with a difference of - 0.019 (95% CI: - 0.0344 to - 0.0036). No significant differences were observed in time to first rescue dose.
conclusionPENG block with 0.25% ropivacaine provides non-inferior analgesia compared to 0.375%, supporting its use in elderly patients to reduce opioid reliance and minimize the risk of local anesthetic systemic toxicity.
trial registrationNot applicable.
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