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JournalFeed PubMetric Report

Analysis Source: PDF full text + PubMed metadata

JournalFeed PubMetric Score

11

High Confidence

PubMetric Score Breakdown

Relevance 2/2

Addresses a common condition with potential practice-changing implications.

Design & Methods 1/2

Single-center retrospective study with propensity score matching.

Bias Risk 1/2

Some concerns due to retrospective design and potential residual confounding.

Results 2/2

Statistically significant reduction in opioid use with clinical relevance.

Certainty & Consistency 1/2

First study of its kind; results need further validation.

Applicability 2/2

PENG blocks can be implemented in ED settings with trained personnel.

Transparency 2/2

Funding present; COI disclosure present.

Critical Appraisal

Study Identification

Title: 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, Ariella Gartenberg, Jonathan Maik, et al.
Journal: The Journal of emergency medicine
Year: 2025
DOI: 10.1016/j.jemermed.2025.08.019
Trial Registration: Not reported
Country / Region: United States
Setting: Single urban level 1 trauma center

Background

Hip fractures are associated with significant morbidity and mortality, and opioids, commonly used for pain control, have poor side effects. PENG blocks may offer a safer, opioid-sparing alternative.

Study Question

Does the use of PENG blocks reduce opioid administration in hip fracture patients compared to conventional opioid analgesia?

Study Design & Conduct

Study Design: Retrospective cohort study
Prospective / Retrospective: Retrospective
Multicenter: No
Unit of Allocation: Not applicable
Unit of Analysis: Patients
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: Up to 24 hours post-index event

Population

Inclusion Criteria:
  • Isolated hip fracture
  • ED visit at a level 1 trauma center
  • Admitted to hospital and underwent repair in OR
Exclusion Criteria:
  • Incarceration
  • Pregnancy
  • Age under 18
  • Significant mechanism of injury
  • Polytrauma
  • Current methadone therapy
  • Intubation in ED
  • Sedative or anxiolytic administration
  • Allergy to sodium channel blockers or opioids
Number Screened: 452
Number Enrolled: 287
Number Analyzed: 287
Key Baseline Characteristics
Age: Mean 81.1 years
Sex: 69.3% female
Disease Severity: Not reported
Care Setting Distribution: ED of a level 1 trauma center
Additional Baseline Characteristics
  • Weight
  • BMI
  • Type of hip injury
  • Medical history
  • Substance use history
  • Renal function
  • Initial mean arterial pressure

Exposures / Interventions

Primary Exposure / Intervention
Description: Pericapsular nerve group (PENG) block
Definition / Dose: 0.25% Bupivacaine
Timing: Between ED arrival and OR arrival
Classification Method: Performed by trained emergency physicians under ultrasound guidance
Protocolized / Discretionary: Protocolized
Comparator / Reference
Description: Conventional opioid analgesia
Definition: Opioid administration between ED arrival and OR arrival

Outcomes & Results

Primary Outcomes
Cumulative opioid administration
Definition: Reduction in morphine milligram equivalents (MME) administered
Time Point: 6 and 18 hours post-index event
Measurement Method: Converted into oral MME per kilogram of body weight
Results: -0.14 MME/kg (95% CI: -0.20, -0.08 at 6 hours; -0.23, -0.04 at 18 hours)
Secondary Outcomes
Hospital length of stay
Definition: Duration of hospital stay
Time Point: Not specified
Measurement Method: Hospital records
Results: Comparable between groups
ICU length of stay
Definition: Duration of ICU stay
Time Point: Not specified
Measurement Method: Hospital records
Results: Comparable between groups
Discharge disposition
Definition: Patient discharge status
Time Point: Not specified
Measurement Method: Hospital records
Results: Comparable between groups

Risk of Bias

Risk of Bias - ROBINS-I
  • Confounding (Some concerns): Propensity score matching used, but residual confounding possible.
  • Selection of participants (Low): Clear inclusion and exclusion criteria applied.
  • Classification of interventions (Low): Interventions clearly defined and classified.
  • Deviations from intended interventions (Low): Interventions were applied as intended.
  • Missing data (Low): No significant missing data reported.
  • Measurement of outcomes (Low): Outcomes measured consistently across groups.
  • Selection of the reported result (Low): All relevant outcomes reported.
Transparency
Funding Disclosed: TRUE
COI Statement Present: TRUE

PubMetric Brief

Take-Home Message
PENG blocks significantly reduce opioid use in hip fracture patients in the ED.

Study Summary
This retrospective cohort study evaluated the effectiveness of pericapsular nerve group (PENG) blocks compared to conventional opioid analgesia in patients with isolated hip fractures in the emergency department. Conducted at a single urban level 1 trauma center, the study included 287 patients, with 36 receiving a PENG block. The primary outcome was the reduction in morphine milligram equivalents (MME) administered. Results showed a significant reduction in opioid administration in the PENG group, with a decrease of 0.14 MME/kg at 6 and 18 hours post-intervention. Secondary outcomes, including hospital length of stay and discharge disposition, were comparable between groups. The study suggests that PENG blocks are an effective opioid-sparing strategy, though larger prospective studies are needed to confirm these findings.

Citation
Pericapsular Nerve Group Block-Augmented Analgesia vs. Conventional Opioid Analgesia for Hip Fracture Patients in the Emergency Department: A Comparative Effectiveness Study . The Journal of emergency medicine. 2025;79:232-245. PMID: 41138560