{
  "abstract": "Background and Aims Hip fractures in frail older adults cause considerable pain, diminished quality of life, and ethical challenges. Regional anesthesia techniques such as the pericapsular nerve group (PENG) are proposed for palliative care, but evidence remains limited. This study evaluates a neurolysis protocol at Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium, and assesses whether the PENG block is sufficient as first-line analgesia in conservatively managed hip-fracture patients.Methods Seven patients considered for ultrasound-guided alcohol neurolysis between September 2024 and March 2025 were reviewed. As per the institutional protocol, a PENG block was used for intracapsular or intertrochanteric fractures, and a femoral nerve (FN) neurolysis for subtrochanteric fractures. In all cases, 10 mL ethanol 96% was used. Pain (VAS/PAINAD), opioid consumption, discharge status, and survival were extracted from hospital and follow-up records. PENG failure (VAS/PAINAD ≥ 4 at 24 h) triggered rescue FN neurolysis; persistent pain prompted multidisciplinary review.Results Seven patients (median age 89 years, ASA IV–V) were evaluated. Of these, one patient had a VAS below 4, one received palliative systemic opioids, and five received neurolysis (3 PENG, 2 primary FN). Two PENG patients required additional FN neurolysis. Overall, 4/5 (80%) FN procedures achieved adequate analgesia (VAS/PAINAD ≤ 4) at 24 h, versus 1/3 (33%) with PENG alone. One patient remained opioid-dependent despite sequential blocks. Three of five treated patients were discharged; 6/7 patients died within 30 days (median survival 12 days).Abstract EP155 Figure 1Flow of patients following the protocolAbstract EP155 Figure 2Palliative hip protocolConclusions In our cohort of frail patients with hip fractures, FN alcohol neurolysis provided more consistent analgesia than PENG neurolysis. In patients with limited survival, the reliability and simplicity of FN neurolysis may outweigh PENG’s motor-sparing advantages.",
  "authors": [
    {
      "affiliations": [
        "Anesthesia, ZOL Genk, Genk, Belgium"
      ],
      "name": "Jona Houthuys"
    },
    {
      "affiliations": [
        "Anesthesia, ZOL Genk, Genk, Belgium",
        "Anesthesia, New York School of Regional Anesthesia (NYSORA), New York, USA"
      ],
      "name": "Astrid Van Lantschoot"
    },
    {
      "affiliations": [
        "Orthopedics, ZOL Genk, Genk, Belgium"
      ],
      "name": "Frans-Jozef Vandeputte"
    },
    {
      "affiliations": [
        "Anesthesia, New York School of Regional Anesthesia (NYSORA), New York, USA",
        "Anesthesia, Noorderhart, Pelt, Belgium"
      ],
      "name": "Fréderic Polus"
    },
    {
      "affiliations": [
        "Anesthesia, ZOL Genk, Genk, Belgium",
        "Anesthesia, New York School of Regional Anesthesia (NYSORA), New York, USA"
      ],
      "name": "Admir Hadzic"
    },
    {
      "affiliations": [
        "Anesthesia, ZOL Genk, Genk, Belgium",
        "Anesthesia, New York School of Regional Anesthesia (NYSORA), New York, USA"
      ],
      "name": "Imré Van Herreweghe"
    }
  ],
  "title": "EP155 Regional neurolysis for palliative hip fracture analgesia: experience from a regional trauma-center",
  "uid": "06cf494f-44d2-5219-b662-b233a24b877c"
}