Comparison Between Ultrasound Guided Pericapsular Nerve Block And Suprainguinal Fascia Iliaca Nerve Block in Hip Surgery (PENG block)

Total hip replacements (THRs) are quite successful surgery for many end-stage hip diseases in terms of pain relief and functional recovery (Lindberg-larsen M et al,2020). However, THR are associated with severe perioperative pain which prolongs length of hospitalization and increases the morbidity and medical cost (Guarino AJ et al,2019). Adequate pain management is crucial for improving the satisfaction of patients and clinical outcomes. Numerous strategies have been implemented to reduce postoperative pain following THR including local infiltration analgesia, epidural analgesia, intravenous non-steroidal anti-inflammatory agents and peripheral nerve block. (Kuchalik J et al,2017).

So, multimodal analgesia has been extensively used in perioperative period of THR (Berninger MT etal, 2019).

One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve.(Standring S,2015). FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region (Madabushi R, 2016). A suprainguinal FICB produces a more complete sensory block of the medial, anterior and lateral region of the thigh when compared to infra-inguinal FICB. Additionally,supra-inguinal FICB leads to a more consistent spread in the cranial direction, thus spreading the anesthetic more consistently towards the lumbar plexus and three targeted nerves. So,the supra-inguinal approach has a superior postoperative analgesic efficacy compared to infra-inguinal approach along with significantly less morphine consumption in the first 24(Garner M,2017).

The pericapsular nerve group (PENG) block, which targets sensory branches of the obturator, accessory obturator, and femoral nerves in the anterior capsule of the hip, has been proposed as an effective method to treat pain associated with hip fractures and total hip arthroplasty(THA)(Giron-Arango L,2018). The PENG block provides coverage of the sensory nerves supplying the anterior hip while sparing motor blockade of the quadriceps; a known complication of fascia iliaca and femoral blocks (Tran J,2019).

PENG block has potential advantages over traditional forms of regional analgesia for pain originating from the hip, such as femoral nerve or fascia iliaca blocks. One of these potential advantages include a wider and more complete coverage of sensory nerves innervating the hip, leading to more effective regional analgesia with the potential to reduce postoperative pain,increase patient satisfaction and allow early mobilization(Bartels K,2016).