The Effect of Pericapsular Nerve Group Block with Liposomal Bupivacaine on Postoperative Rebound Pain in Older Hip Fracture Patients: A Randomized Controlled Trial.

Objective: This study aims to investigate and discuss the effect of pericapsular nerve group (PENG) block with liposomal bupivacaine (LB) on postoperative rebound pain following hip fracture in older adults. Patients and Methods: Ninety patients scheduled for hip fracture surgery were randomized into three groups: LB (liposomal bupivacaine, 30 mL), R (0.375% ropivacaine, 30 mL), and C (saline, 30 mL). MAP and HR were recorded at T1 (pre-induction), T2 (post-intervention), and T3 (skin incision). NRS scores were evaluated at 12-72 h postoperatively, along with rebound pain, quadriceps function, analgesic consumption, and adverse reactions. Results: The incidence of rebound pain was significantly lower in the LB and R groups than in the C group (p < 0.05). The AUC of NRS scores over 72 hours was significantly lower in the LB group (2.053 ± 1.258) than in the R (3.600 ± 2.087) and C (4.880 ± 2.739) groups (p < 0.0001). Hemodynamic analysis revealed significant differences in HR between T2 and T3 in all groups (LB: 77.10 ± 11.28 vs 73.77 ± 8.47; R: 79.57 ± 8.05 vs 74.00 ± 8.13; C: 80.50 ± 8.71 vs 84.13 ± 8.07; p < 0.05). MAP in the LB group differed significantly from Group C across the three time points (p < 0.05). There were no significant differences between the groups in adverse events. Conclusion: LB PENG blockade reduces rebound pain incidence post-nerve block in elderly hip fracture patients, decreases PCA demand, preserves quadriceps function, and enhances satisfaction.