A randomized controlled study of pericapsular nerve group block (PENG block) plus lateral femoral cutaneous nerve block vs patient-controlled intravenous analgesia for postoperative analgesia after hip replacement surgery

Abstract

Background: Postoperative pain often remains troublesome for the patients, if not adequately managed. Various modalities have been tried to keep the patient pain free. Regional nerve blocks under ultrasound guidance have recently gained much popularity. We aimed to compare the pain relief outcomes after hip replacement surgery by continuous Pericapsular Nerve Group Block (PENG Block) in combination with lateral femoral cutaneous nerve (LFCN) block under the guidance of ultrasound versus patient-controlled intravenous analgesia (PCA).

Methodology: Sixty patients, who underwent hip surgery at E University Hospital, Hanoi, Vietnam, from August 2021 to August 2022, were randomly allocated to one of the two groups: group of patients with pain relief with PENG block in combination with LFCN block (PENG group) and the group of patients with patient-controlled intravenous analgesia (PCA group). Outcomes regarding clinical parameters and pain scores on Visual Analogue Scale (VAS), from the initiation of the blocks or the PCA (H0) to 72 h (H72) were recorded and compared.

Results: Sixty patients were included in this study. The average VAS scores at rest in both groups was at low pain level (VAS < 4). The average VAS score in both of the groups at most of the time of the study did not have a statistically significant difference. The VAS on movement at the time points H18, H21, H24, H30, H36, H48, H72 of the PENG group was lower than that of the PCA group and the difference was statistically significant between the two groups (P < 0.05). The rate of vomiting/nausea of patients in the PCA group was significantly higher than in the PENG group (P = 0.006).

Conclusion: Pericapsular nerve block combined with lateral femoral cutaneous nerve block offers prolonged pain relief when compared with traditional patient-controlled intravenous analgesia in postoperative pain relief after hip replacement, and is associated with lower frequency of vomiting/nausea.

Abbreviations: ASA - American Society of Anesthesiologists; AIIS - Anterior Inferior Iliac Spine; IPE - Iliopubic Eminence; LFCN - Lateral Femoral Cutaneous Nerve; PCA - Patient-Controlled Analgesia; PENG - Pericapsular Nerve Group; VAS - Visual Analogue Scale.

Keywords: Pericapsular nerve group block; Lateral femoral cutaneous nerve; Hip replacement; Multimodal analgesia; Ultrasound-guided analgesia; Patient-controlled analgesia; Side effects.

Citation: Dang TV, Hung ND, Quangm NX, Nguyen TH, Tran DV, VU Hoang Phuong VH. A randomized controlled study of pericapsular nerve group block (PENG block) plus lateral femoral cutaneous nerve block vs patient-controlled intravenous analgesia for postoperative analgesia after hip replacement surgery. Anaesth. pain intensive care 2024;28(2):324−328; DOI: 10.35975/apic.v28i2.2441

Received: December 22, 2023; Revised: January 26, 2024; Accepted: January 31, 2024