Background: The lateral approach is commonly used in hip fracture surgery. Pericapsular nerve group (PENG) block cannot block the lateral femoral cutaneous nerve (LFCN), which is involved in sensing the skin incision during the lateral approach. Therefore, we compared the effect of adding the LFCN block to the PENG block on opioid consumption and pain scores in hip fracture operations under spinal anesthesia Methods: In this prospective randomized-controlled study, patients undergoing hip fracture surgery under spinal anesthesia were randomized into 3 groups: PENG, PENG + LFCN, and CONTROL group. In the PENG group, 20 mL of 0.25% bupivacaine was injected under ultrasound guidance, while in the PENG + LFCN group, LFCN block, involving 5 mL of 0.25% bupivacaine, was performed in addition to the PENG block. Spinal anesthesia was the preferred method in all patients. Postoperative opioid consumption, numerical rating scale (NRS) pain scores at 0-, 2-, 6-, 12-, and 24-hours postoperatively and while giving spinal anesthesia position, time of first analgesic requirement, and the time of first mobilization were recorded. Results: A total of 20 patients from each group were included in the statistical analysis. Postoperative opioid consumption was lower in the PENG and PENG + LFCN groups as compared to the CONTROL group, while the PENG and PENG + LFCN groups did not differ significantly (PENG: 8.10 ± 6.72 mg, PENG + LFCN: 8.40 ± 4.38 mg, CONTROL: 15.30 ± 5.59 mg, P < .001). Postoperative NRS pain scores during activity (NRS A ) were significantly lower at all-time points in the PENG + LFCN than in the CONTROL group, and were lower at 2, 6, and 24 hours in the PENG than in the CONTROL group. These scores did not differ significantly between the PENG and PENG + LFCN groups at any time point. The time to first postoperative analgesic requirement was significantly shorter in the CONTROL than in the PENG and PENG + LFCN groups. Conclusion: Addition of an LFCN block to the PENG block did not contribute to postoperative opioid consumption and pain scores in patients undergoing hip fracture surgery under spinal anesthesia. Preoperative PENG block plays an important role both during positioning for spinal anesthesia and in postoperative analgesia management.
Şeker et al. (Fri,) studied this question.