Ultrasound-guided pericapsular nerve group block versus fascia iliaca compartment block for positioning during spinal anesthesia in proximal femur fractures: A prospective randomized comparative study

Background: Positioning patients with proximal femur fractures for subarachnoid block is often painful and challenging. The pericapsular nerve group (PENG) block targets articular branches of the anterior hip capsule and may provide superior movement-related analgesia compared to the fascia iliaca compartment block (FICB). Aims and Objectives: The aim of this study was to compare the median reduction in visual analog scale for dynamic pain (VAS-D, on passive 15° limb elevation) at 30 min after ultrasound-guided PENG versus FICB. Secondary outcomes included visual analog scale for resting pain (VAS-R), ease of spinal positioning (EOSP), time to perform spinal anesthesia, and number of attempts. Materials and Methods: Sixty adults with proximal femur fractures scheduled for spinal anesthesia were randomized to PENG (Group P, n=30) or FICB (Group F, n=30). Both received 20 mL of 0.375% ropivacaine. VAS-R and VAS-D were recorded before block and at 10, 20, and 30 min. Results: Groups were comparable at baseline. Median reduction in VAS-D at 30 min was greater in Group P (7.0 [interquartile range (IQR) 7.0–7.0]) versus Group F (6.0 [IQR 5.0–6.0]; z=3.78, P<0.001). VAS-R reduction did not differ (5.0 vs. 4.0; P=0.082). EOSP scores favored Group P (χ2=13.48, P=0.004), with 86.7% graded 1–2 versus 43.4%. Spinal anesthesia was faster (13.00±2.69 vs. 18.53±3.71 min; P<0.001). First-attempt success was higher (63.3% vs. 36.7%; P=0.104). Conclusion: PENG block provided superior relief of movement-evoked pain, facilitated spinal positioning, and reduced procedure time compared to FICB, with no difference in resting pain.