Peripheral Nerve Group Block Vs Femoral Nerve Block For Analgesia and Positioning in Proximal Femur Fractures: A Randomised Controlled Comparison

Effective pain management is essential for ensuring optimal positioning during spinal anesthesia, especially in complex surgeries such as proximal femur fracture procedures. Proper positioning is critical for the accurate placement of the spinal needle and the overall effectiveness of the block. When patients are in discomfort, they may struggle to maintain the required posture—whether sitting or lying in a specific position—which can compromise the precision of needle placement. Effective pain control before positioning for CNB alleviates this discomfort, allowing patients to remain still and maintain the correct position, which is crucial for a successful CNB and minimizing complications like accidental dural puncture.

Moreover, pain management directly impacts the efficacy of spinal anesthesia. By ensuring that patients are relaxed and comfortable, it enhances the ability to administer the anesthetic precisely where needed, improving the likelihood of achieving the desired level of anesthesia and analgesia. Pain control also helps streamline the procedure by reducing delays associated with repositioning or adjusting the patient due to discomfort. This contributes to a more efficient process and shorter overall procedure time.

In addition to these technical benefits, effective pain management significantly improves the patient experience. Reducing pain and anxiety leads to a more positive experience, which can enhance patient cooperation and reduce overall stress during the procedure. Femoral nerve block is the most widely used standard peripheral block for ease of positioning in proximal femur fracture patients. However , recent advancements in multimodal pain management strategies, incorporating nerve blocks like ultrasound guided pericapsular nerve group block have demonstrated notable improvements in pain scores for ease of positioning in the femur fracture patients. Studies indicate that such strategies can reduce opioid consumption, improve pain scores, and decrease hospital stays. These advancements highlight the importance of preoperative pain management in optimizing recovery and enhancing surgical efficacy, ultimately underscoring its critical role in successful CNB and overall patient care.

There are many studies showing the effects of these two individual blocks for ease of positioning for central neuraxial blockade, but very few showing the comparisons between these blocks to conclude which block gives better pain control for ease of positioning.

For example, Kullenberg B.et al (2004),Francesca L.et al(2008),Purohit S. et al (2017),Acharya U.et al(2020),  Morrison C. et al(2021) are some of the studies showing the effect of femoral nerve block and pericapsular nerve group block on pain control individually for ease of positioning in hip fractures.  However, there are very less studies showing the comparison between these two blocks.

The primary objective of this study was to compare the Ultrasound-guided PENG block and the Ultrasound-guided FNB for ease of positioning for CNB in patients undergoing surgery for proximal femur fractures in terms of pain score(NRS), anaesthesiologist satisfaction score and patient’s satisfaction score.

To achieve these objectives, a randomized controlled trial (RCT) involving patients with proximal femur fractures is conducted from April 2025 to April 2026. Total of 52 Participants were randomly assigned to receive either the USG guided PENG block or USG guided FNB before positioning for CNB in groups of 26 each with injection Ropivacaine 0.2% 15 cc in each patient. Pain scores were assessed using Numerical rating score(NRS). Additionally, patient satisfaction and anaesthesiologist satisfaction were also assesed. The secondary objectives were to check for the total postoperative 24 hours analgesic requirement and quadriceps muscle power.