Pericapsular nerve group block versus Suprainguinal fascia iliaca block for analgesia during positioning for spinal anaesthesia in patients with hip fracture : an observational study.

Spinal anaesthesia is considered as the gold standard for hip surgeries. However severe pain is encountered during positioning of the patients especially for the commonly used hyperbaric spinal. Parenteral opioids, NSAIDS as well as regional nerve blocks like femoral 3 in 1, fascia iliaca blocks etc are being employed  to facilitate patient positioning. Good analgesia during positioning reduces the patient’s suffering, decreases incidence of post traumatic stress, and also makes the procedure easy for the Anaesthesiologist.The Pericapsular nerve group block (PENG) and Suprainguinal fascia iliaca block (SIFI-B) are recently  introduced blocks for positioning pain.

Girón-Arango et al. introduced a new technique,pericapsular nerve group block (PENG), for  selective blockade of the articular branches from the femoral, accessory obturator, and obturator nerve. It has demonstrated sufficient analgesic effect and without any quadriceps weakness in patients with hip fracture.The fascia iliaca block has shown good analgesic efficacy for hip fracture patients with the suprainguinal  approach showing superior results than the infrainguinal approach, due to better spread of local anaesthetic under the fascia iliaca.

These nerve group blocks provides an opportunity for anaesthesiologists to participate in patient’s pain control early on, especially in terms of offering analgesia for effective pain control. The nerve blocks provide superior analgesia with decreased use of opioids and various other benefits. Regional analgesia with neuraxial anesthesia for hip fracture surgery has a multitude of benefits with positive outcomes and will play a major role in pain and perioperative management in the future.

Due to the limited literature comparing newer nerve group blocks i.e. PENG and SIFI-B, we decided to conduct the study.