Experience of PENG-block in palliative non-operative management for hip fractures

Abstract

Introduction: The rise in the elderly has been accompanied by an increase in the incidence of hip fractures. Surgical intervention is the cornerstone of treatment for the majority of these fractures (89.4%), as opposed to non-operative approaches. Nonetheless, on average 13% of the overall hip fracture population dies within on month. Palliative non-operative management (PNOM) is being increasingly considered as a viable option. Pain has been identified as the most important factor influencing the comfort of the patient and their relatives in the last phase of life when choosing PNOM. The standard of treatment of pain is with opioids, which comes together with side effects influencing the quality of life in the last phase of life. Therefore, the objective of this study is to get more insight in the experience of the use of PENG-block in PNOM for frail patients with a hip fracture.

Design: This is a retrospective qualitative study performed in level 2 trauma center in The Netherlands. Semistructured interviews were conducted between July 1st 2022 to 31st of December 2022 to investigate by-proxy reported patient experiences of PNOM with PENG-block after hip fracture.

Results: A total of 15 proxies were subjected to the interview. The median age of the included patient group was 85 years (IQR 76-92), with a median CCI of 5 (IQR 5-7). After thematic analysis, three recurring themes were identified: (1) the decision-making process, (2) pain experience, and (3), the end-of-life stage.

Conclusion: In the majority of cases, PENG-block does not provide adequate pain relief when used as monotherapy. Therefore, opioids are still needed for comfort which coincides with negative side effects and reduced quality of life. Further studies are needed to improve the local pain managemant. Furthermore, the communication on different aspects needs to improve regarding the decisionmaking process, the provided information about the PENG-block, provided information about palliative care and aftercare information between other health-care workers.