Pericapsular Nerve Group Block for Total Hip Arthroplasty
Pericapsular Nerve Group Block for Total Hip Arthroplasty
Controlling pain after hip replacement surgery improves comfort and partient satisfaction.
 Pain after hip replacement has traditionally been managed using systemic pain medications
 including acetaminophen and non-steroidal anti-inflammatory drugs. A recent Cochrane review
 demonstrated that compared to systemic analgesia alone, peripheral nerve blocks reduce
 postoperative pain with moderate-quality evidence. Pericapsular Nerve Group block is a new
 technique allowing local anesthetic diffusion to femoral, obturator and accessory obturator
 nerves and providing a good analgesic effect for hip fracture surgery. Investigators
 hypothesized that the PENG block could be an interesting alternative to systemic analgesiscs
 for pain control after total hip replacement.
The aim of the study was to evaluate the efficacy of the PENG block for intra and
 postoperative pain control in total hip arthroplasty.

 it was a monocentric, randomized, controlled and double blind study. Patients scheduled for
 primary THA with lateral approach under general anesthesia.

 Premedication with IV midazolam 1 to 2 mg on arrival to operating theatre. general anesthesia
 was conducted using fentanyl, propofol and cisatracurium for induction and isoflurane for
 maintanance patients were randomized using a random table in two groups:

 -  PENG Block group (PG) who received 2 mg.kg-1Ropivacaine in 40 ml of saline.

 -  Placebo group (SG) who received 40 ml of saline.

 Postoperative analgesia started before extubation of the patient, with:

 -  IV paracetamol 1g/6h in Day1 and oral paracetamol 1g/8h for 6 days.

 -  non steroidal anti inflammatory drugs with IM piroxicam 20 mg on day one (at the end of
 surgery) and oral diclofenac 50 mg/12h for 3 days.

 -  Morphine PCA for day 1 (24 H) and oral tramadol 50 mg/12h from day 2 to day 6.
Inclusion Criteria:

 -  primary THA with lateral approach under general anesthesia.

 Exclusion Criteria:

 -  Hip fracture,

 -  allergy to local anesthetics,

 -  peripheral neuropathy,

 -  creatinin clearance inferior to 30ml/min,

 -  weight inferior to 50 Kg or superior to 100 Kg,

 -  neurological disorder affecting the lower extremity, significant psychiatric
 conditions,

 -  patients receiving corticosteroid therapy,

 -  chronic consumption of opioids (>2 months).