Is Continuous Ultrasound-guided Pericapsular Nerve Group Block Any Better for Postoperative Pain than Ultrasound-guided Lumbar Plexus Block in Hip Fracture Patients? A Randomized Controlled Trial

Background and Aims: Lumbar plexus block (LPB) (psoas compartment block) and pericapsular nerve group (PENG) block under ultrasound guidance are newer regional anesthesia modalities for giving postoperative pain relief in hip fracture surgeries. However, a direct comparison between these two procedures is mostly lacking. Methods: This is a prospective, randomized, single-blind controlled trial, in which 50 patients of 20–80 years of age, with the American Society of Anesthesiologists Grade I and II physical status, and body mass index 18–35 kg/m 2 received either LPB or PENG block before unilateral hip fracture surgery. Preoperatively, patients were randomized 1:1 to either Group 1 (PENG block) or Group 2 (LPB). Both groups received 15 ml of 0.5% ropivacaine and 2 μg/ml fentanyl combination, along with the provision of 0.2% ropivacaine and 2 μg of fentanyl continuous infusion of 5 ml/h for 48 h. The primary outcome was the postoperative mean pain score over 48 h (using the numeric rating scale) in either group, using the Mann–Whitney U -test. Results: Baseline demographics were similar. At rest, pain scores were significantly lower in PENG block than LPB at 1 h ( P < 0.001), 4 h ( P < 0.001), 8 h ( P < 0.001), 12 h ( P < 0.001), 24 h ( P = 0.008), 36 h ( P = 0.048), and 48 h ( P = 0.011), respectively. The same pattern was observed for pain on movement (all P < 0.001). Postoperative hospital stay length was considerably higher in the LPB group in comparison to the PENG block group ( P = 0.014). Conclusion: PENG block was found to be an efficient analgesic technique with few adverse effects.