A Comparative Analysis of Ultrasound-Guided Erector Spinae Plane Block Versus Combined Ultrasound-Guided Pericapsular Nerve Group (PENG) and Lateral Femoral Nerve Block Following Total Hip Arthroplasty: A Randomized Double-Blind Controlled Clinical Trial

Abstract

Background: In hip fracture surgery, the use of regional anesthesia during the perioperative period is intended to enhance pain management, minimize opioid requirements, and reduce the risk of postoperative complications. Objective: This study aims to examine whether a combined pericapsular nerve group (PENG) block with a lateral femoral cutaneous nerve (LFCN) block provides comparable pain management for total hip arthroplasty (THA) as an erector spinae plane (ESP) block, while minimizing the occurrence of quadriceps muscle weakness. Methods: This randomized double-blind controlled trial enrolled 50 individuals of both genders with American Society of Anesthesiologists class I-III, scheduled for THA with spinal anesthesia. Participants were randomly assigned into two groups of 25. Group A received an ultrasound-guided PENG block with an LFCN block, while group B received an ESP block. The primary outcomes were pain intensity evaluation using the Visual Analogue Scale (VAS) during the first 48 hours, occurrence of moderate-to-severe pain, duration until the first reported pain, timing of the first request for pain relief, and analgesic usage within the initial 48 hours post-operation. Additional outcomes included restoration of hip joint function, time to first walk, and length of hospital stay. Results: Patients in group A demonstrated significantly reduced pain levels at 6, 12, and 24 hours (P < 0.05), shorter time to first pethidine dose, and lower 48-hour pethidine and paracetamol doses compared with group B (P < 0.001). Individuals in group A achieved their first post-treatment walk notably earlier than those in group B (P < 0.001). Conclusions: In THA, the combined PENG and LFCN blocks offer superior postoperative pain relief, reduce opioid use, and shorten the time to first walk compared with the ESP block.