Comparison of the effects of pericapsular nerve group block and anterior quadratus lumborum block on spinal anesthesia positioning pain and postoperative analgesia in patients undergoing surgery for intertrochanteric femur fracture

The aim of this study was to compare the effects of the pericapsular nerve group (PENG) block and the anterior quadratus lumborum block (QLB-3), administered before spinal anesthesia in patients undergoing surgery for intertrochanteric femur fracture, on preoperative pain intensity, pain experienced during positioning for spinal anesthesia, success of spinal anesthesia, postoperative analgesic efficacy, and postoperative opioid consumption. Materials and Methods In this prospective, randomized clinical study, 84 patients operated on for intertrochanteric femur fracture were randomly allocated into two groups: Group P, receiving the pericapsular nerve group (PENG) block (n=42), and Group Q, receiving the anterior quadratus lumborum block (QLB-3) (n=42). Patients aged between 30 and 85 years with ASA physical status I–III were included. In both groups, regional blocks were performed under ultrasound guidance before spinal anesthesia. Resting pain and dynamic pain (defined as pain felt during 15° elevation of the affected extremity) were assessed using the Numeric Rating Scale (NRS; 0–10) before block administration and 30 minutes after the block. Pain experienced during sitting positioning for spinal anesthesia was also recorded using NRS. The success of spinal anesthesia was defined as successful access to the subarachnoid space on the first attempt and was documented. Postoperative pain levels were assessed using NRS at the 1st, 4th, 8th, 12th, and 24th hours. As part of the rescue analgesia protocol, intravenous tramadol hydrochloride at a dose of 1 mg/kg was administered to patients with NRS ≥4. Tramadol hydrochloride administration intervals were not shorter than 6 hours, and the maximum daily dose was limited to 400 mg. Total tramadol hydrochloride consumption within the first 24 hours was recorded and compared between groups. Data were analyzed using IBM SPSS Statistics 25.0 (IBM Corp., Armonk, NY, USA). Results In the preoperative period, resting pain, dynamic pain, and pain during positioning for spinal anesthesia assessed after block administration were significantly lower in Group P (PENG) compared with Group Q (QLB-3). The first-attempt success rate of spinal anesthesia was higher in Group P. In the postoperative period, pain scores were lower in Group Q during the first 12 hours (at the 1st, 4th, 8th, and 12th hours), while no significant difference was observed between groups at 24 hours. Total tramadol hydrochloride consumption within the first 24 hours was significantly lower in Group Q. Conclusion In intertrochanteric femur fracture surgery, the pericapsular nerve group (PENG) block was found to be more effective in reducing preoperative pain and pain experienced during positioning for spinal anesthesia. The anterior quadratus lumborum block (QLB-3) provided stronger and longer-lasting postoperative analgesia and was associated with a significant reduction in opioid consumption.