The surgeon-delivered PENG block combined with local infiltration analgesia in bilateral total hip arthroplasty: a randomised controlled trial.

Abstract

Pericapsular nerve group (PENG) blocks and Local Infiltration Analgesia (LIA) have demonstrated promising results in reducing pain after total hip arthroplasty (THA). However, a surgeon-delivered PENG block combined with LIA has not yet been described. In this randomised controlled trial, 35 patients undergoing simultaneous bilateral THA via a direct anterior approach were enrolled. Each patient received an intraoperative surgeon-delivered PENG block with LIA on one side, while the contralateral side served as a control. Pain scores at rest and during movement, maximum hip flexion, and intravenous opioid consumption were recorded at 1, 6, and 24 hours postoperatively. Pain scores were significantly lower on the infiltrated side at all time points: at rest (<i>p</i> < 0.001-0.007) and during movement (<i>p</i> < 0.001-0.008). Maximum hip flexion improved significantly at 1 hour (6.2°, <i>p</i> < 0.001) and modestly at 6 hours (2.7°, <i>p</i> < 0.05). Opioid consumption averaged 8.31 mg morphine. No significant adverse events occurred. Administration of a surgeon-delivered PENG block with LIA provides superior pain relief and improved early mobility compared to oral and IV pain management alone. This technique offers a promising alternative to the preoperative percutaneous PENG block.