TOPLINE

Older adults who were frail and were managed without surgery for a hip fracture experienced pain relief and some mobility gains after receiving an ultrasound-guided pericapsular nerve group (PENG) block with phenol, although overall survival remained limited.

METHODOLOGY

• Researchers conducted a prospective cohort study to assess whether an ultrasound-guided PENG block with phenol eased pain and improved quality of life in older adults who were frail and opted to avoid surgery for hip fracture.
• They included 103 patients (mean age, 87 years; 39% men) with femoral neck or trochanteric fractures across seven Dutch hospitals between August 2023 and February 2025. All patients were managed without surgery, and 76% had cognitive impairment.
• Clinicians placed a PENG block guided by ultrasound, injecting a mean volume of 10 mL phenol 6% near the hip joint; a second needle was placed in 14% of patients.
• The primary outcome was the health-related quality of life (HRQOL) measured using a relevant questionnaire. Secondary outcomes included pain scores, use of opioids, mobility, and mortality, assessed at 24 hours, 1 week, 30 days, and 3 months.

TAKEAWAY

• Among patients alive and assessable at week 1, the pain domain of the HRQOL questionnaire showed significant improvement from baseline (P < .001). Further, 94% of patients reported acceptable pain at rest, and 81% reported acceptable pain and 8% reported no pain at all during washing and dressing.
• At 1 week, 79% of assessable patients used opioids, with a median dose in oral morphine equivalents of 30 mg/d.
• At 1 week, 45% of assessable patients could perform a bed-chair transfer, whereas 53% remained bedbound. Mobility improved for many by 30 days and 3 months.
• Mortality was 62% at 30 days and 79% at 3 months, with a median survival of 9 days. No procedure-related adverse events were reported.

IN PRACTICE

"The PENG block is a minimally invasive technique that can be performed at the bedside without mobilizing or transporting the patient, thus increasing comfort without the need for sedatives. It enables the use in outpatient clinics or nursing homes, leading to reduction in patient burden by preventing a potential painful and expensive transport to hospital," the researchers reported.

SOURCE

The study was led by Rachel J.H. Smits, MD, of Radboudumc in Nijmegen, Netherlands. It was published online on September 8 in Anaesthesia.

LIMITATIONS

Procedures besides phenol concentration may have differed between sites. Complications may have been underestimated because no additional diagnostic procedures were performed. Follow-up beyond 30 days and 3 months was limited by high mortality.

DISCLOSURES

The study received support from ZonMw. The authors did not declare any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.