Opioid-Sparing Analgesia in Hip Replacement: Insights From the Pericapsular Nerve Group Block

Background- Hip fractures are a major cause of morbidity and hospitalization in the elderly, with surgery being the mainstay of treatment. Effective postoperative pain management is crucial for early mobilization and optimal recovery. Conventional regional techniques such as femoral or fascia iliaca blocks often provide incomplete analgesia and may cause motor weakness, limiting rehabilitation. Due to suboptimal pain control with these methods, higher doses of opioids are frequently required, leading to adverse effects such as respiratory depression, nausea, and delirium. The pericapsular nerve group (PENG) block has emerged as a motor-sparing alternative that may offer superior analgesia while minimizing opioid requirements and related complications. Objective- To evaluate the effect of PENG block on postoperative opioid consumption and recovery after THA. Methods-This prospective observational comparative study included 70 adult patients undergoing THAat a tertiary care centre, North India. Group Areceived ultrasound-guided PENG block plus multimodal analgesia; Group B received multimodal analgesia alone. Postoperative opioid use was recorded in morphine equivalents. Pain scores and quadriceps strength were assessed. Results- Group Ahad lower opioid consumption at 0–12h (12.24 ± 14.27 mg vs 36.51 ± 23.54 mg, p=0.001) and 12–24h (17.21 ± 14.44 mg vs 41.26 ± 21.66 mg, p=0.001). Time to first rescue analgesia was longer in Group A (12.31 ± 9.13 h vs 7.03 ± 3.65 h, p=0.002). Pain scores were lower at 8h and 12h. Quadriceps strength was preserved at 24–48h. No complications were observed. Conclusion- PENG block significantly reduces opioid requirements and improves early pain control in THAwithout impairing motor function.