For frail, elderly patients who forgo surgery after a hip fracture, managing pain can be a serious challenge — and a new study suggests a bedside nerve block with phenol could help. Researchers in the Netherlands followed 103 patients (mean age 87, 76% with cognitive impairment) across seven hospitals who received an ultrasound-guided pericapsular nerve group (PENG) block with phenol 6% instead of undergoing surgery. The results, published in Anaesthesia, showed meaningful pain relief within the first week.

Among patients alive and assessable at one week, pain scores improved significantly from baseline, and mobility gains were seen by 30 days and 3 months. The technique is minimally invasive and can be performed at the bedside — no transport or sedation required — making it practical even in nursing homes or outpatient settings.

By the Numbers:

• 94% of patients reported acceptable pain at rest at 1 week
• 81% reported acceptable pain during activities like washing and dressing
• 45% could perform a bed-chair transfer at 1 week; mobility improved further by 30 days
• Mortality was 62% at 30 days and 79% at 3 months, with a median survival of just 9 days
• No procedure-related adverse events were reported

Why it matters: Hip fractures in frail older adults carry a grim prognosis, and surgery isn't always an option. This study highlights PENG block with phenol as a feasible, low-burden palliative pain management tool that could meaningfully improve comfort and quality of life in this vulnerable population.