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Papers of the Week

2022 Dec




A Retrospective Study of Ultrasound-Guided Pericapsular Nerve Group Block With Dexamethasone: An Excellent Option for Early Mobility Following Total Hip Replacement Surgery.


Background Severe postoperative pain and immobility increase the length of hospital stay and immobility-related life-threatening complications after total hip replacement (THR). Pericapsular nerve group (PENG) block is a recent addition to pain management of neck of femur (NoF) fracture, the use of which has been incorporated into THR as alternative analgesia or as an adjunct with other regional analgesia techniques. The present study primarily aims to assess postoperative mobility. Secondary outcomes measured were the length of hospital stay, pain score, opioid consumption, and side effects. Methods This is a retrospective study of 50 patients who underwent primary THR. Twenty-eight patients received PENG block after spinal anesthesia (PENG Group), seven patients had general anesthesia (GA) with patient-controlled analgesia (PCA) postoperatively (PCA Group), and the remaining 15 received spinal anesthesia with fascia iliaca block (FIB Group). Mobilization was attempted in all patients (ability to stand and walk a few steps with a walker) 10 hours after the end of surgery. Data was collected for average postoperative pain score, time of mobilization, total opioid consumption (till discharge from the hospital), opioid-related side effects, and time of discharge. Results Mobilization was attempted in all patients 10 hours after the end of the surgery, irrespective of their anesthetic technique. In the PENG Group, 26 patients (n=28) could be mobilized after the first 10 hours without opioids. The total morphine requirement until discharge was significantly less in the PENG Group of patients compared to the FIB and GA+PCA patients. The average time of discharge (hours) from the hospital (22.1+/-4.9) was also significantly lower in the PENG Group compared to all other groups (31.7 +/- 3.4, p=<0.01). The average postoperative pain score was significantly low in the PENG Group within the first 48 hours. Conclusion The PENG block helps in early mobilization and enhanced recovery after THR.