Due to increasing life expectancy and the prevalence of obesity, hip arthroplasty
surgeries have been steadily increasing, especially in the last twenty years, and these
patients experience very serious postoperative pain. Postoperative pain control has a
significant impact on earlier ambulation, initiation of physical therapy, better
functional recovery, and patient satisfaction. At the same time, optimal pain management
is of great importance in contributing to the reduction of the duration of hospital stay,
the risk of adverse events such as deep vein thrombosis, and mortality.
Although peripheral nerve blocks have been shown to be effective as part of multimodal
analgesia for successful postoperative pain management, the superiority of nerve blocks
over each other in terms of analgesic efficacy is a subject of research.
This study was planned to show which of the Pericapsular Nerve Group (PENG) Block and
Lumbar Erector Spina Plane Block to be applied to patients undergoing total hip
arthroplasty is more effective in terms of postoperative effective analgesia duration,
perioperative hemodynamic stability, reducing opioid dependence and postoperative
delirium, reducing total opioid consumption, providing early mobilization and shortening
the length of hospital stay.
Pericapsular nerve group (PENG) block is a promising regional analgesia procedure that
protects the motor function of the hip joint by blocking the obturator nerve, femoral
nerve and accessory obturator nerves by injecting local anesthetic between the superior
pubic ramus and psoas muscle tendon. Erector spina plane block (ESPB) has been widely
used at the thoracic vertebral level in 2016 with ultrasound-guided local anesthetic
injection between the erector spinae muscle and the transverse process of the thoracic
vertebra. In a single case study published in 2018, lumbar ESPB (L-ESPB) was used as
postoperative analgesia after hip arthroplasty, and the local anesthetic injected from
the fourth lumbar spine level (L4) spread to the cephalic and caudal directions and
provided satisfactory hip analgesia.
Since both blocks are relatively newly defined blocks, there are limited studies in the
literature and it is aimed to find an answer to the question of which of these two block
types should be preferred by evaluating different parameters in providing postoperative
analgesia in hip arthroplasty surgery.
Pericapsular Nerve Group Block (PENG) (Group P) or Lumbar Erector Spina Plane Block
(Group E) will be applied preoperatively to patients hospitalized in the orthopedics and
traumatology clinic who come to the operating room to undergo Total Hip Arthroplasty
Surgery, after the necessary information is provided and monitoring is provided before
being taken to the operation with spinal anesthesia. Randomization will be done 1:1 with
a computer (using http://www.randomizer.org). Spinal anesthesia will be applied to
patients who have preoperative block.
Patient-controlled analgesia (PCA) will be applied to all patients to evaluate opioid
consumption at the end of the surgery. The patient's total opioid consumption will be
recorded. Pain is a symptom known to be subjective and will be questioned with the
Numeric Rating Scale (NRS), a standardized scale, in order to minimize differences
between patients. At predetermined time points, Baseline 0, peroperative 15th minute, 1st
hour, 2nd hour and postoperative 1st, 3rd, 6th, 12th, 24th hours, the patients' pain
scores with the Numeric Rating Scale (NRS) (0-10; 0-3: mild pain, 4-6: moderate pain,
7-10: severe pain) will be questioned and noted. When the pain score is 4 and above, 20
mg tenoxicam will be administered as rescue analgesia and the total amount required will
be recorded.
In both groups, patients' demographic data, ASA scores, surgery duration, hemodynamic
parameters during the operation (systolic, diastolic blood pressure, mean arterial
pressure, heart rate and SpO2 values), the time when the pain sensation started after the
operation, the block termination process in the service follow-ups, the time when the
additional analgesics was first needed, the dose administered, the numerical rating scale
when the patient was asked to describe the pain intensity numerically, patient
satisfaction scores (4: very satisfied, 3: satisfied, 2: less satisfied, 1: not
satisfied), hospital stay, nausea-vomiting score and other complications related to the
applied blocks will be recorded and followed for the first 24 hours.