Postoperative pain management has an important place in anesthesia practices. In order to
ensure patient comfort after the surgery, to start postoperative rehabilitation early,
and to prevent the process from causing mood disorders such as anxiety and pathological
conditions such as chronic pain syndrome, the pain caused by the operation in the
postoperative period must be effectively relieved. Pericapsular nerve group (PENG) block;
It is a regional anesthesia technique that targets the anterior capsule of the hip joint
and aims to block the joint branches of the accessory obturator nerve and femoral nerve
by administering local anesthetic. Although it has been described recently, controlled
prospective studies in the literature have shown it to be a safe and effective regional
technique for postoperative pain after hip surgery. However, volume studies on this block
are limited.
Therefore, in this study, we aimed to determine the optimal dose by comparing the
effectiveness of PENG block on pain using different local anesthetic volumes
It was planned to be performed with patients who had hip replacement surgery and patients
who are included in the study after obtaining the necessary consents will be randomly
assigned to one of Group I or Group II by sealed envelope method. Patients taken to the
operating room will receive standard monitoring such as ECG, peripheral oxygen saturation
and noninvasive blood pressure monitoring. Midazolam 1 mg IV, fentanyl 1 mcg/kg IV,
propofol 1.5-2 mg/kg IV and rocuronium 0.6 mg/kg IV. After routine anesthesia induction,
the patient will be intubated with the appropriate intubation tube. Anesthesia
maintenance will be provided with 0.8 MAC sevoflurane and remifentanil infusion, as we
apply in our routine. Ventilator parameters will be regulated as FiO2 50%, Vt: 0.8 ml/kg,
and respiratory frequency 10-14/min, so that EtCO2 is in the range of 25-40 mmHg. Near
the end of the operation, our routine analgesic application is 0.1mg/kg IV Morphine will
be administered. After the operation is completed, the pericapsular nerve group block
will be performed by entering the patient's suprainguinal area with a 100 mm block needle
under ultrasound guidance, as in the standard practice of our clinic, and local
anesthetic will be administered to the area between the psoas muscle tendon and the hip
joint. During the procedure, ultrasound will be used to determine the location and
visualize the distribution of the administered drug. The administered drug volume was
planned to be 20 cc of 0.25% bupivacaine for group I patients and 10cc of 0.25%
bupivacaine for group II patients (their concentrations would be the same but their
volumes would be different). Then, the patient will be awakened from anesthesia; Patients
with adequate respiratory effort below sevoflurane 0.2 MAC should receive atropine 0.1
mg/kg and neostigmine 0.05 mg/kg IV, which we routinely use, will be applied and
extubated. Postoperative 30th minute, 4th hour, 6th hour, 12th hour, 24th hour pain
intensities of the patients were evaluated using NRS (Numerical rating Scale) score
(0-10) and postoperative Nausea and Vomiting Descriptive Scale (0 = none, 1 = mild
nausea, 2 = nausea, 3 = vomiting once, 4 = vomiting more than once) will be evaluated and
recorded. At the end of the surgery, patients will be given IV Morphine PCA (patient
controlled analgesia) with a 2 ml bolus at a concentration of 0.5 mg/cc for 15 minutes
and the amount of Morphine used during the hours when the patient's NRS score is recorded
will be recorded. The patients' mobilization time after the operation will be recorded.
0.15 mg/kg IV Ondansetron will be administered for patients with Postoperative Nausea and
Vomiting Descriptive Scale 2 and above. 24 hours after the surgery, patient satisfaction
will be evaluated and recorded on a Likert Satisfaction scale (1-5).
