Comparative effectiveness of ultrasound-guided regional nerve blocks for hip fracture analgesia in the emergency department: a systematic review
DOI:
https://doi.org/10.65759/ny557x34Abstract
Hip fracture produces severe acute pain and complicates emergency assessment and transfers. Regional nerve blocks provide targeted analgesia within multimodal treatment. This review compared ultrasound-guided techniques for adults receiving emergency department care. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through 31 May 2026. Two authors independently screened studies and extracted data. Randomized trials comparing emergency department initiated single-injection blocks with another ultrasound-guided block, placebo, or systemic analgesia were synthesized narratively. Fourteen randomized trials evaluated femoral, fascia iliaca, and pericapsular nerve group blocks. Femoral blocks generally improved analgesia and reduced opioid exposure relative to systemic treatment, with neutral findings in one short-term fentanyl comparison. Femoral and fascia iliaca blocks produced similar pain reductions in a direct comparison. Supra-inguinal fascia iliaca block improved movement pain relative to the classical approach. Pericapsular nerve group block improved early pain relief relative to infra-inguinal fascia iliaca block and reduced rescue analgesia relative to sham. Opioid reduction varied across trials, including a fascia iliaca study reporting identical median six-hour morphine consumption. Ultrasound-guided blocks improve early hip fracture analgesia in emergency care. Technique selection depends on comparator, assessment timing, and patient characteristics. Data supports regional analgesia within multimodal pathways, without establishing one universally superior block.
References
1. Dong Y, Zhang Y, Song K, Kang H, Ye D, Li F. What was the epidemiology and global burden of disease of hip fractures from 1990 to 2019? Results from and additional analysis of the Global Burden of Disease Study 2019. Clin Orthop Relat Res. 2023;481(6):1209–1220. doi: 10.1097/CORR.0000000000002465.
2. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003;58(1)–M81. doi: 10.1093/gerona/58.1.m76.
3. Sanzone AG. Current challenges in pain management in hip fracture patients. J Orthop Trauma. 2016;30(Suppl 1)–S5. doi: 10.1097/BOT.0000000000000562.
4. Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020;11. doi: 10.1002/14651858.CD001159.pub3.
5. Ritcey B, Pageau P, Woo MY, Perry JJ. Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review. CJEM. 2016;18(1):37–47. doi: 10.1017/cem.2015.75.
6. Short AJ, Barnett JJG, Gofeld M, et al. Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(2):186–192. doi: 10.1097/AAP.0000000000000701.
7. Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43(8):859–863. doi: 10.1097/AAP.0000000000000847.
8. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584–591. doi: 10.1111/acem.12154.
9. Morrison RS, Dickman E, Hwang U, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433–2439. doi: 10.1111/jgs.14386.
10. Jang JS, Lee YH, Kandahar HK, et al. Changes in the tumor necrosis factor-α level after an ultrasound-guided femoral nerve block in elderly patients with a hip fracture. Braz J Anesthesiol. 2018;68(6):558–563. doi: 10.1016/j.bjane.2018.04.002.
11. Cooper AL, Nagree Y, Goudie A, Watson PR, Arendts G. Ultrasound-guided femoral nerve blocks are not superior to ultrasound-guided fascia iliaca blocks for fractured neck of femur. Emerg Med Australas. 2019;31(3):393–398. doi: 10.1111/1742-6723.13172.
12. Chen L, Shen Y, Liu S, Cao Y, Zhu Z. Ultrasound-guided supra-inguinal fascia iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial. BMC Geriatr. 2021;21:669. doi: 10.1186/s12877-021-02646-4.
13. Mayel M, Foroughian M, Zamani N, Shahabinejad N, Hassanian-Moghaddam H. Ultrasound-guided femoral nerve block and intravenous fentanyl in pain management of the patients with hip fracture: a prospective, randomized, single blinded clinical trial. Acute Med Surg. 2022;9. doi: 10.1002/ams2.804.
14. Güllüpınar B, Sağlam C, Ünlüer EE, et al. Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department. Ulus Travma Acil Cerrahi Derg. 2022;28(6):832–838. doi: 10.14744/tjtes.2022.67817.
15. Gerlier C, Mijahed R, Fels A, et al. Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomized trial. Eur J Emerg Med. 2024;31(1):18–28. doi: 10.1097/MEJ.0000000000001075.
16. O'Connor RD, Postma S, Van Kamp D, et al. Effect of ultrasound-guided fascia iliaca compartment block on pain management in hip fracture patients: a double-blind placebo-controlled randomized clinical trial. Medicine (Baltimore). 2025;104(40). doi: 10.1097/MD.0000000000044622.
17. Calati P, et al. Effectiveness of pericapsular nerve group block for hip fracture pain management in the emergency department: results of the ED-PENG-B randomised controlled trial. BMC Emerg Med. 2025;25:245. doi: 10.1186/s12873-025-01401-x.
18. Di Pietro S, Maffeis R, Jannelli E, et al. Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial. Anaesthesia. 2025;80(12):1484–1492. doi: 10.1111/anae.16695.
19. Altunbaş E, Kudu E, Unal E, et al. Femoral nerve block vs IV fentanyl for hip fracture pain in the emergency department: a randomized double-blind clinical trial. Am J Emerg Med. 2026;99:359–364. doi: 10.1016/j.ajem.2025.10.044.
20. Vijayan B, Ayyan SM, Palaniappan P, et al. Efficacy of ultrasound-guided PENG block for acute pain relief in adult hip fracture patients: a double-blind randomized trial. Acad Emerg Med. 2026;33(3). doi: 10.1111/acem.70206.
21. Sri-on J, Fusakul Y, Phisaiphun K, et al. Ultrasound-guided pericapsular nerve group block versus intravenous morphine for pain management in older adults with hip fractures: a randomised controlled trial in the emergency department. Emerg Med J. 2026. First published online March 2026. doi: 10.1136/emermed-2025-215388.
22. Exsteen OW, Svendsen CN, Rothe C, Lange KHW, Lundstrøm LH. Ultrasound-guided peripheral nerve blocks for preoperative pain management in hip fractures: a systematic review. BMC Anesthesiol. 2022;22:192. doi: 10.1186/s12871-022-01720-7.
23. Hayashi M, Yamamoto N, Kuroda N, et al. Peripheral nerve blocks in the preoperative management of hip fractures: a systematic review and network meta-analysis. Ann Emerg Med. 2024;83(6):522–538. doi: 10.1016/j.annemergmed.2024.01.024.
24. Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66(4):300–305. doi: 10.1111/j.1365-2044.2011.06628.x.
25. Yeoh SR, Chou Y, Chan SM, Hou JD, Lin JA. Pericapsular nerve group block and iliopsoas plane block: a scoping review of quadriceps weakness after two proclaimed motor-sparing hip blocks. Healthcare (Basel). 2022;10(8):1565. doi: 10.3390/healthcare10081565.
26. Kietaibl S, Ferrandis R, Godier A, et al. Regional anaesthesia in patients on antithrombotic drugs: joint ESAIC/ESRA guidelines. Eur J Anaesthesiol. 2022;39(2):100–132. doi: 10.1097/EJA.0000000000001600.
