Background and aims Hip fracture is a common orthopedic emergency in the elderly, and is frequently associated with significant pain and morbidity. Popular analgesic regimens include peripheral nerve blocks such as femoral nerve block and fascia iliaca block. In this case series, we describe the analgesic efficacy and adverse effects of the recently described pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFC) block, in patients scheduled for urgent total hip arthroplasty (THA), as part of a multimodal pain strategy.
Methods 8 patients scheduled for THA underwent ultrasound-guided LFC (5 ml) and PENG block (15 ml) with 0.375% ropivacaine, followed by spinal anesthesia. Post-operative analgesia included fixed paracetamol and tramadol with IV morphine as rescue analgesia. 24-hour post-operative evaluation comprised analgesic efficacy (pain at rest/with movement), need for rescue analgesia, motor/sensory impairment of the thigh, and other frequent complications such as nausea/vomiting.
Results No patient required rescue analgesia, with only two patients reporting mild pain at rest, and three reporting moderate pain with hip movement. No patient complained of motor blockade, and only one had paresthesia in a small area of the anterior thigh. No other complications were noted.
Conclusions Regional analgesia is commonly used for pain management in patients with hip fractures. Our results show that PENG block may be an overall safe and useful analgesic technique, with a potential motor block-sparing effect and reduction in opioid-related adverse effects. Although in agreement with current literature, further studies are required to address the ideal regional analgesia regimen for hip surgery.