Pericapsular nerve group block-augmented analgesia vs. conventional opioid analgesia for hip fracture patients in the emergency department: A comparative effectiveness study

Authors

William Murk, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York; Department of Emergency Medicine, Montefiore Medical Center, Bronx, New York.
Ariella Gartenberg, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York; Department of Emergency Medicine, Montefiore Medical Center, Bronx, New York; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York. Electronic address: ariella.applebaum@gmail.com.
Jonathan Maik, Department of Emergency Medicine, St Barnabas Hospital, Bronx New York.
Michelle A. Montenegro, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Sarika Antora, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York; Department of Emergency Medicine, Montefiore Medical Center, Bronx, New York.
Aamir Bandagi, Department of Emergency Medicine, St Barnabas Hospital, Bronx New York.
Michael Boulay, Department of Data Sciences and Support, NYC Health + Hospitals, New York, New York.
Julie Clemmensen, Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Trevor Dixon, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Michael Jones, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York; Department of Emergency Medicine, Montefiore Medical Center, Bronx, New York.
Kaushal Khambhati, Department of Quality and Safety, NYC Health + Hospitals, Department of Emergency Medicine, NYC Health + Hospitals/Lincoln Medical Center, Bronx, New York.
Nicole Leonard-Shiu, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Anna Liveris, Department of Surgery, Albert Einstein College of Medicine and NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Philip O'Donnell, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Anthony Scoccimarro, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Jeremy Sperling, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.
Dean Wiseman, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York; Department of Emergency Medicine, Montefiore Medical Center, Bronx, New York.
Anirudh Ramachandran, Advocate Health - MidwestFollow
Michael Halperin, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, New York.

Recommended Citation

Murk W, Gartenberg A, Maik J, et al. Pericapsular Nerve Group Block-Augmented Analgesia vs. Conventional Opioid Analgesia for Hip Fracture Patients in the Emergency Department: A Comparative Effectiveness Study. J Emerg Med. Published online August 18, 2025. doi:10.1016/j.jemermed.2025.08.019

Affiliations

Advocate Christ Medical Center

Abstract

Background: While opioids are frequently used in the emergency department (ED) for pain control of hip fractures, they are associated with poor side effects. The pericapsular nerve group (PENG) block has recently emerged as an opioid-sparing peripheral nerve block for patients with hip fractures.

Objectives: The primary objective was to determine whether there is a reduction in morphine milligram equivalents (MME) administered to patients with hip fractures who receive a PENG block in the ED as compared to those who only receive opioids. Secondary outcomes included hospital length of stay and discharge disposition.

Methods: A retrospective study of patients with isolated hip fractures was performed at a level 1 urban trauma center. Thirty-six patients received a PENG block and 251 patients did not. Patients who received a PENG block were propensity-score matched against those who received opioids. The primary outcome was subsequent cumulative opioid administration.

Results: Patients who received a PENG block had a statistically significant reduction in opioid administration. At 6 hours of follow-up, these patients had a reduction in MME by -0.14 MME/kg (95% CI: -0.20, -0.08), and at 18 hours of follow-up, this reduction was -0.14 MME/kg (95% CI: -0.23, -0.04). Secondary outcomes demonstrated comparable effects on length of stay and discharge disposition.

Conclusion: Emergency physician-performed PENG blocks are an effective opioid-sparing analgesic strategy for isolated hip fractures. Larger prospective studies are needed to evaluate this effect estimate and assess mortality outcomes.

Document Type

Article

PubMed ID

41138560