Regional Anesthesia by PENG-Block in Emergency Department

The study is a single-centre, open-label randomized comparative trial. Adult patients admitted to the emergency department for a hip fracture will be enrolled.Pericapsular nerve block (PENG-block) is a regional anesthesia technique developed primarily as an analgesic technique in a perioperative setting during hip fractures related surgical procedures. Some authors propose the use of PENG-Block as an alternative to fascia iliaca block and femoral block for the analgesic management of hip fracture in the emergency department, but scientific evidence is weak in this setting.The hypothesis of this study is that the use of PENG Block in the emergency department provides a better pain management for patients suffering from hip fractures with less opioid use.

Inclusion Criteria:Adult patients (≥18 years old) admitted to the emergency department for a hip fracturePain assessed by VAS/NRS ≥ 3 when the clinical suspicion of hip fracture is confirmed by the emergency physicianPatients capable of expressing his/her consent prior to participation in the studyAffiliated to or beneficiary of a social security regimenExclusion Criteria:Patients for who it is impossible to collect the pain assessment scalePatients with known or suspected bleeding disorders :Personal and family history of bleeding symptoms (spontaneous or induced)Clinical signs suggesting a haemostasis disorderPatient on anticoagulant at a curative dose with a very high risk of bleeding (labile International Normalized Ratio (INR), mechanical valve, acute kidney failure and treatment with direct oral anticoagulants)Inherited bleeding disorder (Hemophilia A, Hemophilia B, Von Willebrand disease, Fibrinogen deficiency, Factor XII deficiency)Pathologies that may interfere with hemostasis: advanced liver disease, decompensated hematological disease, collagen diseases such as Ehlers-Danlos diseasePatients in whom it is impossible to perform the PENG-Block: Body Mass Index (BMI) > 40, adenopathy or infection at the puncture site, allergy to the anesthetics usedPregnant, parturient or breastfeeding womenPatients under judicial protection or judicial safeguardAny other reason which, in the opinion of the investigator, could interfere with the evaluation of the study objectives