Hip fractures (HF) are one of the most severe, painful and life-threatening emergencies. The majority of these patients are of the elderly age group. In such patients, severe pain alone is known to be associated with a higher risk of delirium, increased mobilization time, extended hospital stays, and poor health outcomes [[1], [2], [3]]. Alleviating pain is the cornerstone of the management of HF, which often requires Intravenous (IV) opioid analgesics. However, a bulk of these patients remain under-medicated in an overcrowded Emergency Department (ED) with limited resources to monitor [4]. Further, the use of opioid analgesics is riddled with aggravated adverse effects like respiratory depression, bradycardia, hypotension and delirium, which are of concern in elderly patients [5]. Alternatively, commonly used Nalbuphine, a synthetic opioid agonist (kappa)-antagonist (mu), which provides comparable analgesia to morphine, prolonged action for up to 8 h and is devoid of undesirable side effects of pure agonists like morphine [6,7].

Another emerging modality for pain alleviation in HF is the pericapsular nerve group (PENG) block. It is a novel block where only the sensory articular branches of the obturator nerve, femoral nerve, and accessory obturator nerve are blocked without causing motor dysfunction like the femoral nerve block and the fascia iliaca block [8]. The PENG block is also advocated as a cost-effective alternative with good analgesia, reduced hospital stay, and high patient satisfaction [9]. It is pertinent for the providers considering integrating the PENG block into their practice to be aware of the risk of local anaesthesia systemic toxicity (LAST).

However, there is a lack of randomised controlled trials (RCT) to substantiate the described benefits of the PENG block. Only a few observational studies have described the benefits of PENG block compared to Tramadol/Paracetamol and femoral nerve block [10,11]. However, the benefits of PENG block compared to IV Nalbuphine (IVN) have yet to be studied.

We conducted this RCT to compare the analgesic effect of ultrasonography (USG) guided PENG block with IVN in patients with HF coming to the ED. Inferences were drawn after careful statistical analysis. Both treatment modalities' adverse effects and rescue analgesic requirements were monitored and analyzed.