Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial
Comparação entre o bloqueio do grupo de nervos pericapsulares e o bloqueio quadrado lombar anterior para cirurgia de fratura de quadril: ensaio clínico randomizado
Mustafa Aslan, Alper Kilicaslan, Funda Gök, Ahmet Fevzi Kekec, Tahsin Sami Colak
Abstract
Objective
This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).
Methods
In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.
Results
No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.
Conclusion
Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.
Keywords
Resumo
Introdução
Este estudo comparou o bloqueio do Grupo de Nervos Pericapsulares (PENG) combinado com o bloqueio do Nervo Cutâneo Femoral Lateral (LFCN) ao bloqueio anterior do Bloqueio do Quadrado Lombar (QLB) em pacientes submetidos à Artroplastia Total de Quadril (THA).
Métodos
Neste ensaio prospectivo, duplo-cego, 80 adultos programados para THA sob anestesia raquidiana foram randomizados para receber bloqueio anterior de QLB (n = 40) com 30 mL de bupivacaína 0,25% ou bloqueio combinado PENG + LFCN (n = 40) utilizando 25 mL de bupivacaína 0,25% para PENG e 5 mL para LFCN. O desfecho primário foi o consumo acumulado de morfina intravenosa nas primeiras 24 horas pós-operatórias. Desfechos secundários incluíram escores de dor, força do quadríceps, satisfação do paciente e efeitos colaterais.
Resultados
Não foram observadas diferenças significativas entre os grupos no consumo de morfina ou escores de dor durante as primeiras 12 horas (p > 0,05). Com 24 horas, o grupo PENG + LFCN apresentou consumo significativamente menor de morfina (p = 0,027) e escores de VAS em repouso mais baixos (p < 0,001). Fraqueza do quadríceps ocorreu em 15% (6/40) dos pacientes do bloqueio anterior de QLB às 6 horas (p = 0,026), enquanto nenhum caso de fraqueza foi observado no grupo PENG + LFCN nas 24 horas avaliadas. A satisfação dos pacientes e a incidência de complicações foram comparáveis entre os grupos.
Conclusão
Tanto o bloqueio anterior de QLB quanto o bloqueio combinado PENG + LFCN proporcionam analgesia eficaz por até 12 horas após a THA. Entretanto, a combinação PENG + LFCN oferece analgesia prolongada, redução na necessidade de opioides e melhor preservação da força do quadríceps.
Palavras-chave
References
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Submitted date:
02/10/2025
Accepted date:
05/03/2025
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