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Abstract
Background and Aims Pericapsular nerve group (PENG) block targets anterior hip joint capsule nerves, and has been used for acute and perioperative pain in hip fractures. Herein, we evaluated the effect of preoperative PENG block on spinal anesthesia positioning pain and postoperative analgesia in hip surgery.
Methods This randomized, controlled, assessor blinded study was conducted between May 2021 and March 2022 following IRB approval. ASA I-III patients aged 35–90 y scheduled for hip fracture surgery were included. In the PENG group (n=40) USG-guided PENG was applied with 20 mL LA, 20m prior to spinal anesthesia whilst in the control group (n=41) 1.5 mcg/kg fentanyl IV was applied 5m prior to spinal anesthesia. Spinal anesthesia, perioperative and postoperative analgesia plans were same for all patients. Peri-positioning and postoperative numeric rating scale (NRS), PCA morphine consumption, time to first opioid requirement were noted for the first 24 hours. Additionally, the quality of recovery (QoR-15) score was determined at the 24th hour.
Results NRS scores were significantly lower in the PENG group at peri-positioning and at postoperative 3rd, 6th and 12th hours (p<0.001). Cumulative morphine consumption was statistically higher in all time points in the control group. Time to first opioid requirement was later in the PENG group (p<0.001) and QoR-15 score averages were significantly higher too (111.02±9.67 vs 99.51±9.45,respectively, p<0.001).
Conclusions PENG block reduces pain associated with spinal anesthesia positioning and improves the quality of the postoperative analgesia regimen when added to a multimodal analgesia plan.