Comparison of peripsular nerve group block and quadratus lumborum block methods in hip fracture

Objective: The optimal postoperative analgesic technique for hip surgery is still controversial. The present study aimed to compare the pericapsular nerve group (PENG) with the lateral femoral cutaneous nerve (LFCN) and quadratus lumbroum blocks (QLB) in terms of analgesic efficacy, quadriceps motor preservation and side effects in patients undergoing total hip arthroplasty (THA) surgery. Methods: After approval was obtained from the local ethics committee, 80 patients (ASA I-III) were randomly allocated to receive either a QLB (n=40) using 30 mL 0.25% bupivacaine or the PENG and LCFN blocks (n=40) using 30 mL 0.25% bupivacaine (25 mL for the PENG block and 5 mL for the LFCN block) in this prospective, double-blind study. The primary outcome was the consumption of postoperative morphine in a multimodal analgesic regimen after spinal anesthesia. The secondary outcomes also included pain scores (static and dynamic), quadriceps muscle strength, patient satisfaction, and incidence of postoperative complications. Results: There was no significant difference between the two groups in terms of morphine consumption and pain scores in the first 12 hours (p>0.05). Patients receiving the combination of the PENG and LFCN blocks had significantly higher quadriceps muscle strength at 6 h, less morphine consumption and static pain scores at 24 h hour, compared to QLB (p<0.05). Patient satisfaction, dynamic pain scores, and block-related complications were similar between the groups (p >0.05). Conclusion: PENG with the LFCN block provides longer analgesia and better preservation of quadriceps strength after THA. However, further studies with larger sample sizes are needed to determine if these differences are clinically significant. Keywords: Hip fracture, lateral femoral cutaneous nerve block, pericapsular nerve group block, quadratus lumborum block, quadriceps muscle strength