PENG Block & PENG PRF

Chronic hip pain is a common clinical condition, particularly in the elderly, that significantly impairs quality of life and leads to functional limitation and dependence in daily activities. Chronic hip pain caused by degenerative, inflammatory, and mechanical conditions-most notably hip osteoarthritis-often remains inadequately controlled despite medical treatment, physical therapy, and rehabilitation. Although surgical interventions can be effective, they are not suitable for all patients due to advanced age, comorbidities, or surgical contraindications. Therefore, minimally invasive interventional pain management techniques have gained increasing importance in the treatment of chronic hip pain.

The nociceptive innervation of the hip joint primarily arises from the anterior capsule, which is mainly supplied by the sensory branches of the femoral, obturator, and accessory obturator nerves. Based on this anatomical rationale, the pericapsular nerve group (PENG) block is an ultrasound-guided technique that targets these sensory fibers to provide effective analgesia without causing motor blockade. Previous studies have shown that the PENG block reduces pain scores and improves functional mobility in both acute and chronic hip pain; however, its analgesic effect may be time-limited, requiring repeated applications in some patients.

Pulsed radiofrequency (PRF), unlike conventional thermal radiofrequency, aims to modulate nerve transmission without causing tissue destruction and may provide longer-lasting analgesia through neuromodulatory mechanisms. Recent evidence suggests that combining PRF with peripheral nerve blocks may prolong analgesic effects compared with nerve blocks alone. However, prospective studies directly comparing PENG block alone with PENG block combined with PRF in chronic hip pain are limited, highlighting the need for further investigation.

Inclusion criteria

• Presence of chronic hip pain lasting at least 3 months
• Baseline Visual Analog Scale (VAS) score ≥ 4
• Clinical and/or radiological diagnosis of hip osteoarthritis
• Inadequate response to conservative treatments

Exclusion criteria

• Local or systemic infection at the intervention site
• Coagulopathy or inability to discontinue anticoagulant therapy
• Hip pain related to malignancy
• History of previous hip arthroplasty
• Severe neurological deficit
• Pregnancy or breastfeeding