Comparison of the effectiveness of epidural analgesis and peng (pericapsular nerve group) block for postoperative pain treatment in hip prosthesis surgery

Aim: To compare the effectiveness of continuous epidural analgesia technique and PENG block for postoperative pain management in patients with total hip replacement surgery. Materials and Methods: After the approval of our hospital's ethics committee and the written consent of the patients, 70 patients aged 18-75 years ASA I-III who were planned to undergo total hip replacement surgery under spinal anesthesia were included in the study. Pericapsular nerve group block (PENG) with 20 ml 0.25% bupivacaine + lateral femoral cutaneous nerve (LFCN) block with 5 ml 0.25% bupivacaine were applied to 35 patients (Group P) with postoperative . In 35 patients (Group E) with postoperative , 0.125% bupivacaine was started as infusion through the epidural catheter at 4cc/h. Both groups were visited at the 2nd, 4th, 8th, 12th, 24th, 36th and 48th hours postoperatively to obtain hemodynamic data, time of first postoperative additional analgesia application, static and dynamic pain scores, total amount of analgesia consumed in the first 24 and second 24 hours and complications. status was recorded. Results: There was no significant difference between the demographic characteristics of both groups. While there was no significant difference in postoperative heart rate (HR) and diastolic blood pressure (DBP) values between the two groups, systolic blood pressure was found to be significantly lower in Group E starting from the 4th hour (p<0.05). The time to first postoperative analgesia was found to be statistically significantly longer in Group P than in Group E (p<0.05). NRS-S and NRS-D were significantly lower in Group P at the 2nd and 4th postoperative hours, while there was no difference between the groups at the 8th hour, they were significantly lower in Group E at the 12th, 24th, 36th and 48th hours. While there was no significant difference between the two groups in terms of additional analgesic consumption in the first 24 hours, the total amount of analgesic consumed in the second 24 hours was significantly lower in Group E. When Bromage scores were compared, they were found to be statistically lower in favor of the PENG group at the 4th hour (p<0.05). At other hours, no significant difference was observed between the two groups (p>0.05). While no complications were observed in the PENG group, hypotension was observed in 11 patients, nausea-vomiting in 3 patients, and nerve dysfunction was observed in 1 patient in the epidural group. There was no statistically significant difference between the groups in terms of satisfaction score and hospital stay (p>0.05). Conclusion: As a result of this study, it was shown that hemodynamics were better preserved in the PENG group compared to the epidural group in cases undergoing total hip replacement surgery and that it provided analgesia as effective as epidural analgesia. We believe that PENG block will be an alternative for postoperative analgesia in patients who fail to place an epidural catheter, which is a technically more difficult procedure. Key Words: Total hip replacement, NRS, postoperative analgesia, PENG.