Ultrasound-Guided PENG Block Delivers Superior Pain Relief in Frozen Shoulder, RCT Finds
A recent randomized controlled trial published in the Indian Journal of Anaesthesia demonstrates that ultrasound-guided pericapsular nerve group (PENG) block delivers superior motor-sparing pain relief and enhanced mobility following shoulder manipulation under anesthesia. Patients receiving the PENG block achieved significantly lower 24-hour pain scores of 2.6 compared to 3.6 with intra-articular steroid injections.
Adhesive capsulitis causes painful shoulder stiffness affecting 2% to 5% of the population, and while manipulation under anaesthesia (MUA) is frequently performed with intra-articular corticosteroid injections, conflicting evidence regarding steroid efficacy highlights a clear clinical gap for superior regional analgesia. Addressing this gap, Sangeeta Dhanger and colleagues from Indira Gandhi Medical College and Research Institute, Puducherry, conducted a randomized controlled trial comparing PENG block against intra-articular steroid injection in patients undergoing MUA.
Therefore, the single-center randomized controlled trial evaluated 127 patients with stage 2 or 3 adhesive capsulitis scheduled for manipulation under anesthesia (MUA), comparing an ultrasound-guided pericapsular nerve group (PENG) block against an intra-articular steroid injection. Excluding individuals with prior shoulder trauma or surgery, researchers primarily assessed 24-hour Numerical Pain Rating Scale (NPRS) scores alongside Range of Motion (ROM) and Shoulder Pain and Disability Index (SPADI) outcomes.
Key Clinical Findings of the Trail Includes:
- Superior Post-Procedural Analgesia: NPRS scores were significantly lower in PENG recipients than steroid controls up to 24 hours, recording 4.1 versus 5.2 at 15 minutes and 2.6 versus 3.6 at 24 hours (P < 0.001) (Dhanger).
- Enhanced Mobility Restoration: PENG blockade produced significantly greater ROM gains across all five shoulder movement planes at 15 minutes and 24 hours post-procedure compared to steroid administration (P < 0.001) (Dhanger).
- Greater Functional Improvement: Mean SPADI scores at 24 hours demonstrated a significant disability reduction of 71.7% in the PENG cohort versus 68.1% in the steroid cohort (P = 0.022) (Dhanger).
- Favorable Safety Profile: Neither interventional technique resulted in procedural complications, hematomas, or nerve injuries during the 24-hour post-procedural observation window (Dhanger).
The results suggest that PENG block provides effective pain relief and functional restoration following MUA in patients with adhesive capsulitis, attaining a significantly lower mean pain score of 2.6 compared to 3.6 for steroid injection at 24 hours. Additionally, PENG block recipients achieved a superior 71.7% reduction in shoulder disability, confirming its clear therapeutic advantage over intra-articular steroid injection.
Thus, the trial concludes clinicians may consider incorporating motor-sparing PENG block as a complementary regional analgesic strategy alongside targeted hydrodilatation and structured physiotherapy to optimize post-manipulation recovery in adhesive capsulitis.
While limited by an unblinded operator, single-center setting, 24-hour follow-up window, and non-matched injectate volumes, these findings highlight regional analgesia potential and warrant future multicenter randomized trials with extended monitoring to evaluate long-term therapeutic durability.
Reference
Dhanger S, Natrajan P, Vaidiyanathan B, Kandavelu A. Comparison of intra-articular steroid injection and pericapsular nerve group block for pain control and functional outcomes in patients undergoing manipulation under anaesthesia for frozen shoulder – A randomised controlled trial. Indian J Anaesth 2026;70:733-40.
