Attitudes of anesthesiologists towards implementation of PENG block in non-operative treatment of hip fractures in the Netherlands: a national survey study

BACKGROUND: Effective pain management in frail patients with hip fractures who are not candidates for surgery remains challenging. The pericapsular nerve group (PENG) block with phenol has been proposed as a minimally invasive option in this context. However, its integration into palliative care pathways is not well established. This study evaluated how Dutch anesthesiologists perceive the PENG block with phenol for non-operative pain management and explored the current state of its implementation. METHODS: We conducted a national cross-sectional survey among all registered anesthesiologist-pain specialists in the Netherlands (N = 192). The survey assessed perceived barriers and facilitators to implementation, categorized at the system, staff, and intervention levels. Secondary outcomes included perceptions of acceptability, feasibility, and appropriateness. RESULTS: Sixty anesthesiologists completed the survey (adjusted response rate 31%), of whom 88% reported prior experience with the PENG block using phenol. Reported barriers included uncertainty about long-term efficacy (57%), logistical constraints (48%), and limited training opportunities (35%). Facilitators were the availability of clear protocols (55%) and an expanding evidence base (50%). Respondents largely considered the block technically straightforward and clinically appropriate, particularly for femoral neck fractures. Nevertheless, feasibility concerns were highlighted regarding referral pathways and interdepartmental collaboration. CONCLUSIONS: Dutch anesthesiologists widely accept the PENG block with phenol as an appropriate option for pain management in selected frail patients with hip fractures in the non-operative setting. Implementation is currently constrained by evidence gaps, logistical barriers, and institutional variability. Targeted staff-, intervention-, and system-level strategies may facilitate broader adoption, including structured residency training, institutional protocols with patient education tools, and interdisciplinary collaboration across relevant specialties. Further evidence and national guideline development are needed to facilitate standardized practice and international implementation.