Analgesic efficacy of the ultrasound-guided pericapsular nerve group (PENG) block for ambulatory hip arthroscopy: a...

Hip arthroscopy is an increasingly common outpatient surgical procedure where postoperative pain can be severe. Peripheral nerve blocks have been evaluated for analgesia following hip arthroscopy; however, there is no consensus on an optimal technique that provides effective local anesthetic-based postoperative analgesia without motor blockade. We hypothesized that the pericapsular nerve group (PENG) block would provide effective motor-sparing analgesia following ambulatory hip arthroscopy.

We conducted a randomized placebo-controlled double-blind trial comparing an ultrasound-guided PENG block with 20 mL of 0.5% ropivacaine to a control with a sham injection. Our primary outcomes were cumulative opioid consumption (oral morphine equivalent) and quality of recovery (QoR-15) scores at 24 hours postoperatively. Secondary outcomes included pain, postoperative opioid consumption, time to first analgesic request, postanesthesia care unit (PACU) length of stay, and opioid and block-related side effects.

94 patients were included (47 per group). QoR was similar between groups at 24 hours as measured by the QoR-15 (range 0-150, higher scores indicate better recovery): mean SD 96.8±20.9 in the PENG group versus 101.0±20.9 in the control group (mean difference -4.2; adjusted p=0.414). Opioid consumption at 24 hours was also similar between groups. In adjusted analyses, the PENG group required less opioid analgesia in the PACU (mean difference -9.5 MME; p=0.039) and had a shorter PACU stay (mean difference -20.5 min; p=0.027). Pain scores at rest and on movement decreased over time in both groups, with no consistent differences in overall pain trajectories. Opioid consumption at 48 hours, opioid-related adverse effects and block-related complications were similar between groups.

When administered preoperatively, the PENG block provides only modest early perioperative benefits without improving overall postoperative analgesia or QoR in patients undergoing ambulatory hip arthroscopy. Based on these findings, routine preoperative use of the PENG block for ambulatory hip arthroscopy cannot be recommended beyond standard multimodal analgesia, although it may be considered selectively to facilitate early PACU recovery in carefully chosen patients. The potential role of postoperative PENG block as a rescue intervention warrants further investigation.

NCT03449680; https://clinicaltrials.gov/study/NCT03449680.