Comparison of Pericapsular Nerve Group Block and Quadratus Lumborum Block

Comparison of Pericapsular Nerve Group Block with Lateral Femoral Cutaneous Nerve Block and Quadratus Lumborum Block for Total Hip Arthroplasty

Adequate pain management following total hip arthroplasty (THA) is a key component for patient satisfaction and early ambulation. However, due to the complexity of the innervation of the hip joint, the most appropriate anaesthetic and analgesic technique for THA remains unclear. A femoral nerve block is commonly performed and well established but is associated with motor weakness. Recently, the pericapsular nerve group (PENG) block has been introduced as an effective choice which targets the articular branches of the hip. The quadratus lumborum block (QLB) is a relatively new regional block that has been reported to provide effective analgesia for THA.

The main objective of this study is to compare the effectiveness of the ultrasound-guided PENG block technique compared to QLB block in terms of efficacy of pain control and the safety profile after total hip arthroplasty under spinal anesthesia.

The patients will be randomly classified into two equal groups (40 patients each). Group allocation will be done by computer generated random numbers and closed opaque sealed envelopes. The study will be designed to be double blind as all patients and outcomes assessor will be blinded to group assignment.

Patients will be randomized to one of three equal groups:

Group I (n= 40 patients): Patients in this group will receive an ipsilateral single shot of QLB (30 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

Group II(n= 40 patients): patients in this group will receive an ipsilateral single-shot of PENG block (25 ml of plain bupivacaine 0.25%) and LFCN block (5 ml of plain bupivacaine 0.25%) after surgery using ultrasonographic guidance.

Inclusion Criteria:

Physical status according to American Society of Anesthesiologists (ASA ) I-III

Exclusion Criteria:

• Younger than 40 years old and older than 85
• Patients undergoing general anesthesia
• Allergy or intolerance to one of the study medications
• Infection of the skin at the site of the needle puncture,
• Patients who do not accept the procedure
• History of bleeding diathesis
• ASA IV,
• Chronic gabapentin/pregabalin,opioid use
• Hepatic or renal insufficiency
• Previous operation on the same hip
• BMI >40