Comparative evaluation of ultrasound-guided quadratus lumborum block versus pericapsular nerve group block for opioid-free post-operative analgesia in unilateral hip surgeries as part of enhanced recovery after surgery protocol: A prospective randomized study

Background: Hip surgeries are associated with significant post-operative pain, which can delay mobilization and recovery. Ultrasound-guided regional anesthesia techniques, such as the Quadratus Lumborum (QL) block and Pericapsular Nerve Group (PENG) block, offer opioid-sparing analgesia. Comparative data on their efficacy for hip surgery remain limited. Aims and Objectives: The aim of the study was to compare the analgesic efficacy, opioid-sparing effect, ambulation time, and patient satisfaction between ultrasound-guided QL and PENG blocks in unilateral hip surgeries. Materials and Methods: In this prospective, randomized, double-blind study, 88 American Society of Anesthesiologists I–II patients aged 18–60 years undergoing unilateral hip surgery under spinal anesthesia were allocated to receive either ultrasound-guided PENG block (Group A) or QL block (Group B). Primary outcome was post-operative paracetamol consumption in 24 h. Secondary outcomes included Visual Analog Scale (VAS) scores at 0, 6, 12, and 24 h, time to first rescue analgesia, ambulation time, patient satisfaction score, and adverse effects. Data were analyzed using unpaired t-test, Chi-square/Fisher’s exact test, with P<0.05 considered significant. Results: Group A had significantly lower VAS scores at 6 h (2.1±0.9 vs. 3.6±1.1, P=0.001) and 12 h (2.5±1.0 vs. 3.8±1.2, P=0.002), longer time to first rescue analgesia (9.5±1.7 h vs. 6.3±2.1 h, P=0.003), and lower paracetamol requirement (1905.93±450 mg vs. 2915.19±651.77 mg, P=0.0001). Ambulation was earlier (9.10±1.56 h vs. 10.73±2.36 h, P=0.0026), and satisfaction scores higher (8.63±0.6 vs. 8.03±0.91, P=0.004) in Group A. Adverse effects were minimal and comparable. Conclusion: PENG block provided superior early analgesia, reduced analgesic use, earlier mobilization, and higher patient satisfaction compared to QL block, with similar safety.