1154 Efficacy of Pericapsular Nerve Group Block (PENG) in Day-Case Total Hip Replacement

Aim Traditional regional anaesthetic blocks in total hip replacement, such as femoral nerve or fascia-iliaca blocks, provide excellent analgesia but at the expense of quadriceps muscle weakness and thus preclude early mobilisation. The pericapsular nerve group block (PENG) targets the articular branches of the femoral, obturator and accessory obturator nerves by injecting local anaesthetic in the plane between the pubic ramus and the iliopsoas tendon. PENG can be combined with a lateral femoral cutaneous nerve block (LFCN) to cover cutaneous innervation at the site of surgery. This study aims to evaluate the effects of PENG with LFCN block in day-case total hip replacement. Method A case-series of 14 consecutive day-case total hip replacement patients. Anaesthetic conduct included short acting prilocaine spinal anaesthesia followed by PENG and LFCN under ultrasound performed by a consultant anaesthetist. Multimodal analgesia included paracetamol, NSAID and high dose dexamethasone. Results The mean post-operative visual analogue scores (VAS) for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation from anaesthesia stop time was 188 minutes (90 – 360 minutes). The mean post-operative opioid consumption was 25mg (0 – 55mg). There were no nerve block related complications. The 30-day readmission rate was 0. Conclusions Our experience highlights the feasibility and potential advantages of employing a precise and targeted regional anaesthetic strategy for total hip arthroplasty. This case series demonstrates that this anaesthetic regimen offers excellent pain relief while preserving motor function, thus enabling the provision of total hip arthroplasty as a day-case procedure.