Effectiveness of combined PENG block and lateral femoral cutaneous nerve block with intravenous dexamethasone in total hip arthroplasty: a prospective, randomized study

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Abstract

BACKGROUND: Although total hip arthroplasty is one of the most frequently performed orthopedic procedures worldwide, the problem of postoperative analgesia remains unresolved. The pericapsular nerve group block (PENG block) has proven to be an effective analgesic technique for total hip arthroplasty; however, its effect does not extend to the skin of the anterior and lateral thigh. For this reason, the PENG block is recommended to be supplemented with a lateral femoral cutaneous nerve block (LFCNB), yet studies evaluating their combined use in total hip arthroplasty remain limited.

AIM: This study aimed to evaluate the effectiveness of combined PENG block and LFCNB with intravenous dexamethasone in patients undergoing total hip arthroplasty.

METHODS: This was a single-center, prospective, randomized study conducted in 90 patients undergoing primary total hip arthroplasty under spinal anesthesia. Patients were randomized into two groups: group 1, PENG block + LFCNB + dexamethasone + spinal anesthesia (n = 45); group 2, spinal anesthesia alone (n = 45). Pain intensity was assessed using the numeric rating scale over 48 hours, and the ability to initiate ambulation at first verticalization after total hip arthroplasty was evaluated. Additionally, the following were assessed: time to the first opioid analgesic injection and its total consumption, the presence of postoperative nausea and vomiting, quadriceps femoris muscle strength (MRC scale), and patient satisfaction with anesthesia (QoR-15 questionnaire).

RESULTS: In group 1, postoperative pain intensity (at rest and during movement) was lower at all assessment time points compared with group 2 (p < 0.05). At first verticalization, more patients in group 1 began walking (86.67%) compared with group 2 (42.22%) (p < 0.001). Total opioid consumption during the first postoperative day was lower in group 1 (p < 0.001). Quadriceps muscle strength assessed 6 hours after total hip arthroplasty was lower in group 1 (p = 0.016). Patients in group 1 were more satisfied with the quality of recovery after anesthesia during postoperative day 1 after total hip arthroplasty (QoR-15 score 130 [125; 136]) compared with patients in group 2 (117 [111; 125]) (p < 0.001).

CONCLUSIONS: The combination of PENG block, LFCNB, and intravenous dexamethasone provides effective analgesia, accelerates rehabilitation, and improves recovery outcomes after total hip arthroplasty.

About the authors

Maksim A. Terenin

6th City Clinical Hospital, Minsk

Author for correspondence.
Email: jack_66@mail.ru
ORCID iD: 0009-0001-6683-8821
SPIN-code: 8443-0482
Belarus, Minsk

Uladislav V. Rymasheuski

Belarusian State Medical University

Email: rimwlad@gmail.com
ORCID iD: 0000-0003-4516-8192
SPIN-code: 1897-9814

MD, Dr. Sci. (Medicine), Assistant Professor

Belarus, Minsk

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