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Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty
  1. Julián Aliste1,
  2. Sebastián Layera1,
  3. Daniela Bravo1,
  4. Álvaro Jara1,
  5. Gonzalo Muñoz1,
  6. Cristián Barrientos2,
  7. Rodrigo Wulf2,
  8. Julián Brañez2,
  9. Roderick J Finlayson3 and
  10. De Q Tran4
  1. 1Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
  2. 2Orthopedic Surgery, University of Chile, Santiago, Chile
  3. 3Pain and Research, The University of British Columbia, Kelowna, British Columbia, Canada
  4. 4Anesthesiology, McGill University, Montreal, Québec, Canada
  1. Correspondence to Dr Julián Aliste, Anesthesiology and Perioperative Medicine, University of Chile, Santiago 8380456, Chile; julian.aliste{at}uchile.cl

Abstract

Background This randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%.

Methods Forty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours.

Results Compared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; p<0.001) and 6 hours (25% vs 85%; p<0.001). Furthermore, pericapsular nerve group block also provided better preservation of hip adduction at 3 hours (p=0.023) as well as decreased sensory block of the anterior, lateral, and medial thighs at all measurement intervals (all p≤0.014). No clinically significant intergroup differences were found in terms of postoperative pain scores, cumulative opioid consumption at 24 and 48 hours, ability to perform physiotherapy, opioid-related side effects, and length of hospital stay.

Conclusion For primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration.

Trial registration number NCT04402450.

  • nerve block
  • pain
  • postoperative
  • pain management
  • lower extremity
  • acute pain

Data availability statement

Data are available on reasonable request. The deidentified data are available on reasonable request to the corresponding author.

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Data availability statement

Data are available on reasonable request. The deidentified data are available on reasonable request to the corresponding author.

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Footnotes

  • Twitter @AlisteJulian, @s_layera, @danibrava, @jaroncio

  • Contributors SL, JA, DB, AJ, GM, CB, RW and JB participated in the planning, conception, design, conduct, reporting, acquisition of data, data analysis, and interpretation of data. RJF and DQT participated in the planning, conception, design, data analysis, and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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