DOI: 10.1213/xaa.0000000000002267 ISSN: 2575-3126

Effects of Combined Pericapsular Nerve Group and Iliohypogastric Nerve Blocks on Postoperative Pain and Opioid Consumption After Total Hip Arthroplasty: A Randomized Clinical Trial

Fredrik Fellert, Fredrik Sjövall, Gunnar Flivik, Andreas Ekman
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BACKGROUND:

Optimal analgesia after total hip arthroplasty (THA) remains uncertain. This trial evaluated whether adding ultrasound-guided pericapsular nerve group (PENG) and iliohypogastric nerve blocks (IHGNBs) to standardized multimodal analgesia improves postoperative analgesia after THA.

METHODS:

In total, 215 patients undergoing THA were randomized to receive PENG plus IHGNB or no block. The primary outcome was pain intensity at rest assessed using a numeric rating scale (NRS) on arrival in the postanesthesia care unit (PACU), at 1, 2, and 3 hours after arrival, at ward admission, in the evening on the day of surgery, on the morning of postoperative day 1, at 14:00 on postoperative day 1, and on day 14. Secondary outcomes included oral morphine equivalent (OME) consumption, length of stay, and adverse events.

RESULTS:

Median NRS on arrival in the PACU was as follows: 0 interquartile range (IQR) 0 to 0 vs 0 IQR 0 to 2.25, P = .022 at 1 hour; 0 IQR 0 to 2 vs 0 IQR 0 to 3, P = .914 at 2 hours; 0 IQR 0 to 2.75 vs 0.5 IQR 0 to 3.25, P = . 568 at 3 hours; 2 IQR 0 to 3 vs 2 IQR 0 to 3.25, P = .551 at ward admission; 2.5 IQR 1.25 to 5 vs 4 IQR 2 to 5, P = .743 in the evening on the day of surgery; 3 IQR 1.25 to 4.75 vs 4 IQR 2 to 5, P = .600 on the morning of postoperative day 1; 3 IQR 2 to 4.5 vs 2.5 IQR 1 to 4, P = .216 at 14:00 on postoperative day 1; 2 IQR 1 to 4 vs 2 IQR 1 to 3, P = .706 on day 14; and 1 IQR 0 to 2 vs 1 IQR 0 to 2, P = .219. OME consumption was lower in the block group among patients who received general anesthesia (mean [standard deviation {SD}], 23.4 [11.2] mg vs 34.7 [12.8] mg, P = .014). Sensory deficits were more prevalent in the nerve block group on day 1, 13/92 (14.1%) vs 2/86 (2.3%), P = .006, and on day 14, 13/89 (14.6%) vs 1/87 (1.1%), P = .001, whereas motor deficits were infrequent.

CONCLUSIONS:

Adding the PENG block and IHGNB to multimodal analgesia did not provide consistent analgesic benefits after THA. Sensory deficits were more frequent after block placement. The finding of lower opioid consumption in patients receiving general anesthesia warrants further investigation.

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