Comparison of Local Anesthetic Concentration in Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty Under Spinal Anesthesia: A Randomized Controlled Trial
Pain Physician, cilt.29, sa.3, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 29 Sayı: 3
- Basım Tarihi: 2026
- Dergi Adı: Pain Physician
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: analgesia, PENG, pericapsular nerve group block, postoperative pain, Total hip arthroplasty
- İstanbul Üniversitesi Adresli: Evet
Özet
Background: The pericapsular nerve group (PENG) block is a novel regional technique that provides adequate postoperative analgesia without producing motor weakness during hip surgery. Objectives: We sought to compare the postoperative analgesic effectiveness of the PENG block with varying concentrations of local anesthetic in total hip arthroplasty. Study Design: Prospective, randomized, double-blind trial registered with the ClinicalTrials.gov (NCT04900116). Setting: Department of Anesthesiology, Istanbul University Faculty of Medicine, Istanbul, Turkey. Methods: Ninety-one patients aged 18–80 with an American Society of Anesthesiologists Physical Status Classification of I–III undergoing total hip arthroplasty under spinal anesthesia with a PENG block were included in this study. Patients were divided into 4 groups: Group One received 20 mL of 0.5% bupivacaine; Group 2 received 20 mL of 0.25% bupivacaine; Group 3 received 20 mL of 0.125% bupivacaine; and Group 4 received 20 mL of saline as a control. Visual Analog Scale pain scores, morphine consumption, nausea, vomiting, and quadriceps weakness were evaluated at postoperative hours 0 (the end of surgery), 6, 12, 24, and 48. In addition, we recorded the first ambulation time; breakthrough morphine need; hospitalization duration; patient and surgeon satisfaction; preoperative and postoperative first month Beck-depression scores; and any complications. Results: Groups One and 2 had significantly lower Visual Analog Scale scores and morphine consumption than the control group (P = 0.001 and P = 0.001, respectively). Quadriceps weakness was significantly higher in Group One at postoperative hour 0 (P = 0.011). Nausea and vomiting were significantly lower in Group One than in the other groups at postoperative hours 12 and 24 (P = 0.007 and P = 0.027, respectively). The length of hospital stay was significantly shorter in Group One than in the control group (P = 0.048). Limitations: This was a single-center study with no standardized quantitative measurement method for assessing quadriceps weakness. Conclusion: The PENG block with 20 mL of 0.5% bupivacaine in total hip arthroplasty provides effective postoperative analgesia by reducing opioid side effects and hospital stay, as evidenced by low pain scores and morphine consumption.