Peng block vs. supra-inguinal fascia iliaca block: a comparative analysis of analgesia duration and motor blockade in hip surgery patients

Hip fractures and surgeries in the elderly are associated with significant morbidity and mortality. Optimal pain control is crucial in perioperative management, facilitating early mobilization, reducing complications such as deep vein thrombosis and pulmonary embolism, and improving overall outcomes. Regional anesthesia techniques are frequently employed to provide effective analgesia while preserving motor function.

The Pericapsular Nerve Group (PENG) block and Supra-inguinal Fascia Iliaca Block (SIFI) have gained attention for hip surgery analgesia. The PENG block, a newer technique, specifically targets articular branches of the femoral, obturator, and accessory obturator nerves innervating the anterior hip capsule. Performed under ultrasound guidance, it is designed to spare motor nerves, minimizing quadriceps weakness. This motor-sparing property is particularly advantageous in elderly patients, allowing early physiotherapy and ambulation.

The SIFI block, a modification of the traditional fascia iliaca block, involves a higher injection site to facilitate spread toward the lumbar plexus. It provides broad coverage of the femoral, lateral femoral cutaneous, and obturator nerves. While offering robust analgesia, it has higher potential for motor blockade due to extensive nerve involvement, particularly affecting the quadriceps, which may delay postoperative mobilization.

Despite growing utilization, there is lack of consensus regarding their comparative efficacy. Current literature presents conflicting results, with most studies limited by small sample sizes or heterogeneous methodologies.

Our study aims to compare the PENG block versus SIFI block in hip surgery patients. Primary endpoints include analgesia duration, measured using standardized pain scores and time to first rescue analgesia, and degree of motor blockade assessed through objective motor function scales. Secondary outcomes include patient satisfaction, ease of administration, and incidence of complications.

Understanding these techniques’ differential effects is crucial for guiding anesthesiologists toward the most appropriate block based on individual patient needs. In an aging population where functional preservation is as important as pain control, selecting a block providing effective analgesia without compromising mobility is essential