Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial

Giuseppe Pascarella; Fabio Costa; Alessandro Strumia; Alessandro Ruggiero; Luigi Maria Remore; Tullio Lanteri; Anton Hazboun; Ferdinando Longo; Francesca Gargano; Lorenzo Schiavoni; Alessia Mattei; Felice Eugenio Agrò; Massimiliano Carassiti; Rita Cataldo

doi:10.3390/jcm13092674

Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial

J Clin Med. 2024 May 2;13(9):2674. doi: 10.3390/jcm13092674.

Authors

Giuseppe Pascarella¹, Fabio Costa¹, Alessandro Strumia¹, Alessandro Ruggiero², Luigi Maria Remore¹, Tullio Lanteri¹, Anton Hazboun¹, Ferdinando Longo¹, Francesca Gargano¹, Lorenzo Schiavoni¹, Alessia Mattei¹, Felice Eugenio Agrò^{1

2}, Massimiliano Carassiti^{1

2}, Rita Cataldo^{1

2}

Affiliations

¹ Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
² Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy.

Abstract

Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.

Keywords: analgesia; anesthesia; nerve block; postoperative pain; regional anesthesia; total hip arthroplasty.

Grants and funding

This research received no external funding.