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Background <p>This study aimed to establish the median effective dose (ED<sub>50</sub>) and 95% confidence interval (CI) of 0.25% ropivacaine for ultrasound-guided pericapsular nerve group (PENG) block for facilitating spinal anesthesia positioning in elderly patients with intertrochanteric femoral fractures.</p> Methods <p>The elderly patients received elective proximal femoral nail antirotation (PFNA) surgery under spinal anesthesia. By adjusting the needle bevel orientation toward the superior pubic ramus, an ultrasound-guided PENG block was administered five minutes before positioning. The dose of 0.25% ropivacaine was titrated according to the highest pain level reported on the visual analog scale (VAS) during positioning, starting from 10&#xa0;ml with subsequent adjustments in 1&#xa0;ml increments. The modified Dixon Up-and-Down sequential method was used to determine the effective dose, and the median ED<sub>50</sub> along with its 95% CI for 0.25% ropivacaine were calculated using Probit analysis. VAS scores were recorded at baseline, 5&#xa0;min after block administration, and during positioning. Postoperative sufentanil consumption and block-related complications—including bleeding, hematoma, quadriceps weakness, and local anesthetic toxicity—were also documented.</p> Results <p>A total of thirty elderly patients with intertrochanteric femoral fractures were enrolled. The ED<sub>50</sub> of 0.25% ropivacaine for a PENG block to facilitate spinal anesthesia positioning was determined to be 3.674&#xa0;ml (95% CI: 1.879–4.842&#xa0;ml). At five minutes post-block, both the VAS score during passive movement and the highest VAS score recorded during positioning were significantly reduced compared to pre-block values. However, no significant differences were observed in postoperative VAS scores, postoperative sufentanil consumption, or the incidence of complications.</p> Conclusion <p>For elderly intertrochanteric fracture patients, ED<sub>50</sub> of 0.25% ropivacaine PENG block was 3.674&#xa0;ml. By adjusting the needle bevel orientation, a low-dose local anaesthetic can effectively relieve pain without affecting quadriceps strength.</p>

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The median effective dose of ropivacaine for ultrasound-guided peripheral nerve block around the hip capsule in elderly patients with intertrochanteric fractures

  • 期刊论文

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  • 发表日期：

    2026年4月10日

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  • Shengyu Jin,
  • Chenyu Wang,
  • Qinghua Wu,
  • Pinhui Ke,
  • Chunlan Lin,
  • Pusheng Ren,
  • Zui Zou,
  • Yaohua Yu,
  • Liangqing Lin

摘要

Background

This study aimed to establish the median effective dose (ED50) and 95% confidence interval (CI) of 0.25% ropivacaine for ultrasound-guided pericapsular nerve group (PENG) block for facilitating spinal anesthesia positioning in elderly patients with intertrochanteric femoral fractures.

Methods

The elderly patients received elective proximal femoral nail antirotation (PFNA) surgery under spinal anesthesia. By adjusting the needle bevel orientation toward the superior pubic ramus, an ultrasound-guided PENG block was administered five minutes before positioning. The dose of 0.25% ropivacaine was titrated according to the highest pain level reported on the visual analog scale (VAS) during positioning, starting from 10 ml with subsequent adjustments in 1 ml increments. The modified Dixon Up-and-Down sequential method was used to determine the effective dose, and the median ED50 along with its 95% CI for 0.25% ropivacaine were calculated using Probit analysis. VAS scores were recorded at baseline, 5 min after block administration, and during positioning. Postoperative sufentanil consumption and block-related complications—including bleeding, hematoma, quadriceps weakness, and local anesthetic toxicity—were also documented.

Results

A total of thirty elderly patients with intertrochanteric femoral fractures were enrolled. The ED50 of 0.25% ropivacaine for a PENG block to facilitate spinal anesthesia positioning was determined to be 3.674 ml (95% CI: 1.879–4.842 ml). At five minutes post-block, both the VAS score during passive movement and the highest VAS score recorded during positioning were significantly reduced compared to pre-block values. However, no significant differences were observed in postoperative VAS scores, postoperative sufentanil consumption, or the incidence of complications.

Conclusion

For elderly intertrochanteric fracture patients, ED50 of 0.25% ropivacaine PENG block was 3.674 ml. By adjusting the needle bevel orientation, a low-dose local anaesthetic can effectively relieve pain without affecting quadriceps strength.