Pericapsular Nerve Group Block Versus Intrathecal Morphine for Analgesia After Total Hip Arthroplasty

Comparison of the Efficacy of the Pericapsular Nerve Group (PENG) Block Versus Intrathecal Morphine for Postoperative Analgesia Following Total Hip Arthroplasty

The Pericapsular Nerve Group (PENG) block is an effective method for postoperative pain management in patients undergoing primary total hip arthroplasty (THA) via a posterolateral approach. The application of this technique reduces postoperative opioid requirements, thereby limiting the risk of adverse effects associated with systemic opioid administration. Effective pain control and a reduced incidence of side effects may translate into higher patient satisfaction and a decreased length of hospital stay (LOS). The PENG block serves as an effective component of multimodal analgesia and may provide an alternative to intrathecal morphine in patients undergoing primary total hip arthroplasty via a posterolateral approach, where the primary anesthetic technique is spinal anesthesia with hyperbaric bupivacaine.

Objectives

1. To evaluate the efficacy of the PENG block in postoperative pain control and compare its effectiveness with intrathecal morphine administration.
2. To assess the impact of the PENG block on postoperative opioid consumption in comparison to analgesia achieved via intrathecal morphine.
3. To analyze the incidence of selected adverse effects associated with systemic opioid administration in patients receiving a PENG block versus those in the intrathecal morphine group.
4. To evaluate patient satisfaction levels regarding postoperative pain management across the different analgesic modalities.
5. To analyze the correlation between the type of analgesia employed and the duration of hospitalization.

Inclusion Criteria:

• Informed, written consent for study participation.
• Qualification for elective primary total hip arthroplasty via a posterolateral approach.
• Age above 18 years.
• ASA Physical Status I-III.
• Absence of contraindications to spinal anesthesia.
• Absence of contraindications to performing a Pericapsular Nerve Group (PENG) block.
• Absence of contraindications to the administration of the pharmacological agents utilized in the study.

Exclusion Criteria:

• Absence of informed consent.
• Age below 18 years.
• Psychoactive substance abuse or dependence.
• Chronic opioid therapy.
• Contraindications to spinal anesthesia.
• Contraindications to the Pericapsular Nerve Group (PENG) block.
• Contraindications to the administration of study medications.
• Body Mass Index (BMI) above 30 kg/m^2.
• Pregnancy.
• History of chronic pain management.