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Abstract
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Background and Aims Pericapsular nerve group(PENG)block provides an effective blockade to the articular branches of the femoral,obturator and accessory obturator nerves compared with the fascia iliaca compartment block(FICB).We aimed to compare the efficacy of these two blocks for enhancing recovery in elderly patients scheduled for hip fracture surgery.
Methods This study was a prospective randomized clinical trial. We included consenting patients undergoing hip fracture surgery. Patients with dementia or clinically significant cardiovascular, renal, hepatic or neurological illness were excluded. Patients were randomly divided into 2 groups to receive either ultrasound-guided PENG block(PENG group)or FICB(FICB group),using 20 ml of 0.2%ropivacaine.Spinal anesthesia was performed after 20 min.The primary outcome was the Quality of Recovery-15(QoR-15)scores at 24h postoperatively.The secondary outcomes were to compare the quadriceps weakness and the VAS at rest and on movement on postoperative day1.
Results Eighty patients were randomized and equally allocated between the two groups.Baseline demographics and preoperative QoR-15 values were similar for the two groups.The postoperative QoR-15 was better in the PENG group compared to the FICB group with a statistically significant difference(p=0.04).The median increase of the QoR-15 at 24h after surgery was 20[14.5-29.75]in the PENG group versus 14[8.5-29]in the FICB group(p=0.04).Weakness of the quadriceps was significantly more observed in the FICB group (p=0.05).There was no statistically significant difference in terms of analgesic efficiency between groups on day 1 postoperatively:static VAS at 1[0-2]vs.2[0-3](p=0.31),dynamic VAS at 3.5[2-5]vs.4[3-4.5](p=0.67)in the PENG group and the FICB group respectively.
Difference in the QoR-15 scores between preoperative and postoperative periods in both groups. Table: Weakness of the quadriceps 1 day after each block
Conclusions The PENG block provides a better quality of recovery after hip fracture surgery with preservation of quadriceps muscle strength.