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Background and Aims PENG block is a novel regional method in hip surgeries that provides adequate postoperative analgesia without motor weakness. The aim of this study was to compare the postoperative analgesia effectiveness of PENG block with different local anaesthetic doses in total hip arthroplasty(THA) surgeries.

Methods 91 patients aged 18-80 years, ASA I-III, undergoing THA surgery under spinal anaesthesia and PENG block were included in this prospective randomized controlled study registered with the Clinical Trials(NCT04900116). The patients were divided into 4 groups using a computer software. PENG block; 20ml of 0.5%bupivacaine in Group-1, 20ml of 0.25%bupivacaine in Group-2, 20ml of 0.125%bupivacaine in Group-3 and 20ml of saline in Group-4 as control group. VAS score, morphine consumption, nausea-vomiting, quadriceps weakness was evaluated at 0,6,12,24, and 48hours postoperatively. In addition, the first mobilization time, breakthrough opioid need, hospital stay, patient and surgeon satisfaction, preoperative and postoperative 1-month Beck-depression scores and complications were recorded.

Results In Groups-1&2, VAS scores and morphine consumption were significantly lower than the control group(p=0.001,p=0.001,respectively). Quadriceps weakness was significantly higher in Group-1 at 0th hour(p=0.011). Nausea and vomiting were significantly lower in Group-1 than the other groups at the 12th and 24th hours(p=0.007,p=0.027,respectively). The length of hospital stay was significantly shorter in Group-1 compared to the control group(p=0.048).

Conclusions We believe that PENG block applied with 20ml 0.5%bupivacaine in THA surgeries provides more ideal postoperative analgesia by reducing opioid side effects and hospital stay with low pain scores and morphine consumption despite early quadriceps weakness.