Comparison of postoperative analgesic effectiveness of suprainguinal fascia iliaca block (SFIB) and pericapsular nerve group block (PENG) in total hip arthroplasty

Introduction and Objective: Pain management after total hip arthroplasty is extremely important. Peripheral nerve blocks are an important part of analgesia. In our study, we aimed to compare the ongoing postoperative analgesic activities of SFIB and PENG with 24-day total morphine consumption as part of multimodal analgesia in total hip arthroplasty under spinal anesthesia. Material and Method: Ethical approval was obtained from Balıkesir University Clinical Research Ethics Committee (Decision No: 2022/171) and Turkish Ministry of Health, Turkish Medicines and Medical Devices Agency Clinical Research Ethics Committee (Decision No: 22-AKD-168). The study included 60 patients aged 18-75 years, body mass ındex ≤35kg/m², ASA I-III, who volunteered for elective total hip arthroplasty. Prior to undergoing the surgical procedure, the subjects were randomly assigned to two distinct groups: the first group, designated as SFIB and the second group, designated as PENG. Patients undergoing total hip arthroplasty under spinal anesthesia under standard ASA monitoring in the preoperative period, without premedication, under sterile conditions, using 30 mL of 0.25% bupivacaine (Marcaine 0.5% AstraZeneca) solution, USG-guided SFIB or PENG block was performed. During the intraoperative period, the pain level was evaluated using the Numeric Rating Scale (NRS). The following procedures were performed: electrocardiogram, oxygen saturation with pulse oximetry, non-invasive blood pressure monitoring, and temperature monitoring. The duration of the operation and the anesthesia were meticulously documented. Postoperative pain was evaluated at 1, 3, 6, 12, 18, and 24 hours by means of the Numeric Rating Scale (NRS), with ratings given for both rest and movement. The total amount of morphine consumed, the nausea-vomiting scores, the number of patients requesting rescue analgesics, and the QoR-15T satisfaction score was categorized and recorded. Results: A statistical analysis revealed no significant discrepancy in total morphine consumption between the groups during the postoperative period. However, Group 1 exhibited a reduced morphine consumption. No substantial disparities were observed between the groups with respect to intraoperative pain levels during spinal anesthesia positioning, postoperative rest and movement, nausea-vomiting scores, the number of patients requesting rescue analgesics, and QoR-15T satisfaction scores. Conclusion: In patients undergoing total hip arthroplasty, the administration of SFIB and PENG block as part of multimodal analgesia is a viable option due to their capacity to provide analogous analgesia during the perioperative period. It is imperative that further research be conducted to assess the efficacy of these blocks across diverse patient populations and practitioner specialties. Key words: Total hip arthroplasty, suprainguinal fasial plane block, pericapsular nerve group block, multimodal analgesia, opioid.