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

Abstract

Background: 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.

Methods: 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.

Results: Pain scores were significantly lower on the infiltrated side at all time points: at rest (p < 0.001-0.007) and during movement (p < 0.001-0.008). Maximum hip flexion improved significantly at 1 hour (6.2°, p < 0.001) and modestly at 6 hours (2.7°, p < 0.05). Opioid consumption averaged 8.31 mg morphine. No significant adverse events occurred.

Conclusions: 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.