Articles
Vol. 3 No. 1 (2025)
Comparative efficacy of pericapsular nerve group block versus fascia iliaca block in postoperative analgesia for total hip arthroplasty: a retrospective observational study
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 5 August 2025
332
Views
201
Downloads
Authors
Effective postoperative pain management is essential to optimize outcomes in total hip arthroplasty (THA). While the fascia iliaca (FI) block has been commonly used, the pericapsular nerve group (PENG) block has emerged as a potentially more targeted alternative. This study aimed to compare the analgesic efficacy and safety of the PENG block versus the FI block in patients undergoing elective THA. In this retrospective observational study, 30 patients scheduled for primary elective THA were divided into two groups: one receiving an FI block (40 mL of 0.25% ropivacaine + 4 mg dexamethasone) and the other a PENG block (20 mL of 0.25% ropivacaine + 4 mg dexamethasone), both performed under ultrasound guidance. Pain scores were assessed using the Numeric Rating Scale (NRS) at 0, 6, 12, 18, and 24 hours postoperatively. Additional outcomes included opioid consumption, time to ambulation, and adverse events. The PENG group reported significantly lower NRS scores at all time points (p<0.05), with the most pronounced difference observed immediately postoperatively and at 24 hours. Time to ambulation was significantly shorter in the PENG group (9.2±2.1 hours vs. 11.6±2.8 hours; p=0.01). Opioid consumption and incidence of adverse events were similar between groups. The PENG block provided superior early postoperative analgesia and facilitated earlier mobilization compared to the FI block in patients undergoing elective THA, without increasing opioid use or complications. These findings support its integration into multimodal analgesic protocols for hip surgery.
Downloads
Download data is not yet available.
Citations
1. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780-5. DOI: https://doi.org/10.2106/JBJS.F.00222
2. Röstlund T, Kehlet H. High-dose local infiltration analgesia after hip and knee replacement: systematic review and meta-analysis. Br J Anaesth 2014;113:843-52.
3. Pepper AM, Mercuri JJ, Behery OA, Vigdorchik JM. Total Hip and Knee Arthroplasty Perioperative Pain Management: What Should Be in the Cocktail. JBJS Rev 2018;6:e5. DOI: https://doi.org/10.2106/JBJS.RVW.18.00023
4. Bugada D, Bellini V, Lorini LF, Mariano ER. Update on Selective Regional Analgesia for Hip Surgery Patients. Anesthesiol Clin 2018;36:403-15. DOI: https://doi.org/10.1016/j.anclin.2018.04.001
5. Vermeylen K, Desmet M, Leunen I, et al. A prospective randomized double-blind comparison of the analgesic efficacy of the pericapsular nerve group (PENG) block versus the fascia iliaca block in hip fracture surgery. Reg Anesth Pain Med 2021;46:874-80. DOI: https://doi.org/10.1136/rapm-2021-102997
6. Desmet M, Vermeylen K, Van Herreweghe I, et al. A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med 2017;42:327-33. DOI: https://doi.org/10.1097/AAP.0000000000000543
7. Girón-Arango L, Peng PWH, Chin KJ, et al. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med 2018;43:859-63. DOI: https://doi.org/10.1097/AAP.0000000000000847
8. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg 2020;131:411-48. Erratum in: Anesth Analg 2020;131:e241. DOI: https://doi.org/10.1213/ANE.0000000000005245
9. Desai DJ, Shah N, Bumiya P. Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series. Cureus 2023;15:e36374. DOI: https://doi.org/10.7759/cureus.36374
10. Iacovazzo C, Sara R, Buonanno P, et al. The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study. Diagnostics (Basel) 202417;14:827. DOI: https://doi.org/10.3390/diagnostics14080827
11. Aliste J, Layera S, Bravo D, et al. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med 2021;46:874-8. DOI: https://doi.org/10.1136/rapm-2021-102997
12. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop 2020;91:3-19. DOI: https://doi.org/10.1080/17453674.2019.1683790
13. Lavand'homme PM, Kehlet H, Rawal N, Joshi GP; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J Anaesthesiol 2022;39:743-57. DOI: https://doi.org/10.1097/EJA.0000000000001691
14. Coviello A, Bernasconi A, Balato G, et al. Positioning the Catheter Tip Anterior or Posterior to the Saphenous Nerve in Continuous Adductor Canal Block: A Mono-Centric Retrospective Comparative Study. Local Reg Anesth 2022;15:97-105. DOI: https://doi.org/10.2147/LRA.S383601
15. Coviello A, Spasari E, Ianniello M, et al. Intra-procedural catheter displacement for continuous adductor canal block: Catheter-through-needle method vs catheter-through-split-cannula method. Perioper Care Oper Room Manag 2022;27:100255. DOI: https://doi.org/10.1016/j.pcorm.2022.100255
16. Choi YS, Park KK, Lee B, et al. Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial. J Pers Med 2022;12:408. DOI: https://doi.org/10.3390/jpm12030408
17. Gasanova I, Alexander JC, Estrera K, et al. Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med 2019;44:206-11. DOI: https://doi.org/10.1136/rapm-2018-000016
18. Coviello A, Iacovazzo C, Cirillo D, et al. Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study. Drug Des Devel Ther 2024;18:1231-45. DOI: https://doi.org/10.2147/DDDT.S442808
19. Anger M, Valovska T, Beloeil H, et al; PROSPECT Working Group* and the European Society of Regional Anaesthesia and Pain Therapy. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021;76:1082-97. DOI: https://doi.org/10.1111/anae.15498
20. Townsend D, Siddique N, Kimura A, et al. Lumbar Erector Spinae Plane Block for Total Hip Arthroplasty Comparing 24-Hour Opioid Requirements: A Randomized Controlled Study. Anesthesiol Res Pract 2022;2022:9826638. DOI: https://doi.org/10.1155/2022/9826638
21. Santonastaso DP, de Chiara A, Righetti R, et al. Efficacy of bi-level erector spinae plane block versus bi-level thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: a prospective randomized comparative study. BMC Anesthesiol 2023;23:209. DOI: https://doi.org/10.1186/s12871-023-02157-2
22. Santonastaso DP, de Chiara A, Addis A, et al. Ultrasound guided erector spinae plane block for post-operative pain control after caesarean section. J Clin Anesth 2019;58:45-6. DOI: https://doi.org/10.1016/j.jclinane.2019.05.009
23. Coviello A, Esposito D, Galletta R, et al. Opioid-free anesthesia—dexmedetomidine as adjuvant in erector spinae plane block: a case series, J Med Case Rep 2021;15:276. DOI: https://doi.org/10.1186/s13256-021-02868-5
24. Petrucci E, Giron F, Sanchez-Ledesma MJ, Manassero A. The FRONT block: Femoral Rami and Obturator Nerve Trunk – a novel approach for anterior hip analgesia. Reg Anesth Pain Med 2024;49:109-11.
25. Hoerner E, Stundner O, Putz G, et al. Crystallization of ropivacaine and bupivacaine when mixed with different adjuvants: A semiquantitative light microscopy analysis. Reg Anesth Pain Med 2022;47:625-9. DOI: https://doi.org/10.1136/rapm-2022-103610
26. Jaeger P, Grevstad U, Koscielniak-Nielsen ZJ, et al. Does dexamethasone have a perineural mechanism of action? A paired, blinded, randomized, controlled study in healthy volunteers. Br J Anaesth 2016;117:635-41. DOI: https://doi.org/10.1093/bja/aew318
27. Williams BA, Hough KA, Tsui BY, et al. Neurotoxicity of adjuvants used in perineural anesthesia and analgesia in comparison with ropivacaine. Reg Anesth Pain Med 2011;36:225-30. DOI: https://doi.org/10.1097/AAP.0b013e3182176f70
28. Desmet M, Braems H, Reynvoet M, et al. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth 2013;111:445-52. DOI: https://doi.org/10.1093/bja/aet109
How to Cite
Comparative efficacy of pericapsular nerve group block versus fascia iliaca block in postoperative analgesia for total hip arthroplasty: a retrospective observational study. (2025). Advances in Anesthesia and Pain Medicine, 3(1). https://doi.org/10.4081/aapm.50.
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
