Comparison of Femoral Nerve Block and Combined PENG Plus Femoral Nerve Block in Geriatric Hip Surgery

Hip fracture surgery in geriatric patients is frequently associated with severe perioperative pain, which may complicate positioning for spinal anesthesia and increase perioperative opioid requirements. Regional analgesic techniques are commonly used to improve patient comfort and reduce opioid consumption in this vulnerable population. The femoral nerve block is a well-established method for analgesia in hip surgery, while the pericapsular nerve group (PENG) block has emerged as a novel technique targeting articular branches of the hip joint with potential advantages in pain control. This prospective randomized controlled trial aims to compare the analgesic efficacy of femoral nerve block alone versus a combined pericapsular nerve group (PENG) plus femoral nerve block in geriatric patients undergoing hip fracture surgery under spinal anesthesia. The primary outcomes include perioperative pain intensity, opioid consumption within the first 24 hours postoperatively, and the need for additional analgesia during positioning for spinal anesthesia. Secondary outcomes include spinal anesthesia procedure duration, time to sensory block onset, time to first postoperative opioid requirement, and perioperative hemodynamic parameters. The results of this study are expected to clarify whether the addition of the PENG block to femoral nerve block provides superior perioperative analgesia and improved patient comfort compared with femoral nerve block alone in geriatric hip fracture surgery.

Inclusion Criteria: * Age 65 years and older, * Patients scheduled for surgery due to hip fracture, * American Society of Anesthesiologists (ASA) physical status I-III, * Body mass index between 18 and 40 kg/m², * Preoperative fasting duration of approximately 8 hours, * Planned spinal anesthesia, * Ability to provide written informed consent. Exclusion Criteria: * Age below 65 years, * Refusal to participate in the study, * Severe cognitive impairment, dementia, or Alzheimer's disease, * ASA physical status IV or higher, * Body mass index \> 40 kg/m², * Failed spinal anesthesia or conversion to general anesthesia, * Revision hip surgery, * Multiple trauma patients, * Old hip fractures (\>3 weeks), * Active malignancy receiving chemotherapy or radiotherapy, * Active infection requiring antibiotic treatment (except prophylaxis), * Contraindications to regional anesthesia techniques, * Chronic steroid or immunosuppressive therapy, * Use of anti-inflammatory drugs, * Non-fasted patients, * Allergy or intolerance to local anesthetics, paracetamol, tramadol, or other opioids.