Background <p>Anesthesia management is crucial for elderly patients undergoing transcatheter aortic valve implantation (TAVI). Conscious sedation (CS) is often preferred, but additional methods need to be utilized. The Pericapsular nerve group (PENG) block is a regional anesthesia technique that provides analgesia in the hip and groin.</p> Objective <p>Our study aimed to investigate the role of PENG block in CS in patients undergoing TAVI. The primary outcome was the need for intraoperative additional fentanyl. Secondary outcomes included postoperative pain scores (NRS), rescue analgesia use (meperidine), and adverse events.</p> Methods <p>Patients with American Society of Anesthesiologists physical status III-IV scheduled for elective TAVI under CS were enrolled in the study. The patients were randomized into two groups PENG group (<i>n</i> = 30) and local infiltration control group (<i>n</i> = 30). PENG block was performed with 30 ml of 0.25% bupivacaine 20 min before TAVI. Propofol infusion (1 mg/kg/hour) and fentanyl as a rescue regimen (1 mcg/kg) was used for CS.</p> Results <p>The PENG group required significantly fewer additional doses of fentanyl for sedation and analgesia during the intraoperative period compared with the control group (70 [60–77.5] μg vs. 90 [60–140] μg, <i>p</i> = 0.001). The PENG group also had significantly lower pain scores at the first postoperative hour (NRS at rest, 0 (0–1) vs. 3 (2–3), <i>p</i> = 0.001) and reduced the need for postoperative rescue analgesia use (meperidine) (0 [0–0] mg vs. 35 [30–40] mg, <i>p</i> = 0.001).</p> Conclusion <p>The PENG block provided effective analgesia and reduced the fentanyl requirement during TAVI under CS. The PENG block may be a beneficial choice to improve the quality of CS in these patients.</p> Trial registration <p>NCT05904912.</p> Graphical Abstract <p>CS, Conscious sedation; PENG, Pericapsular nerve group; TAVI, Transcatheter aortic valve implantation</p> <p></p>