European Journal of Cardiovascular Medicine

Hip surgery, whether performed for fractures, arthroplasty, or other orthopaedic conditions, is associated with substantial postoperative pain, which can significantly impact on patient’s recovery and overall quality of life. Effective pain management following hip surgery is critical not only to minimize discomfort but also to promote early mobilization and accelerate recovery. (1)

Traditionally, opioid medications have been utilized for pain control; however, their associated side effects, including nausea, vomiting, sedation, and the risk of addiction, have led to increased interest in alternative analgesic strategies, particularly regional anaesthesia. (2)

In recent years, nerve blocks have emerged as an effective method for providing targeted analgesia in hip surgery. Among the various regional anesthesia techniques available, the Pericapsular Nerve Group (PENG) block and the Suprainguinal Fascia Iliaca Block (FICB) are two innovative and widely studied approaches, both of which target the nerves responsible for sensory innervation of the hip joint. (3)

Although both the PENG block and FICB are considered effective in providing analgesia for hip surgery, they differ in their anatomical targets and technical aspects. However, the optimal nerve block among these two for postoperative pain management in hip surgery remains a subject of debate, and the relative efficacy of these blocks in terms of pain relief and opioid consumption is still unclear. (4)

Despite the growing use of both techniques, there is limited comparative evidence on their relative efficacy. Furthermore, there is a lack of consensus regarding their duration of analgesia in the perioperative setting.

Our study aims to compare the postoperative analgesic efficacy of the PENG block versus the suprainguinal FICB in patients undergoing hip surgery, with respect to postoperative pain relief, opioid requirement, and duration of analgesia.

Objective:

To compare the post operative analgesic efficacy of pericapsular nerve group (PENG) block versus suprainguinal fascia iliaca (FICB) block in hip surgery.

Table 1. Baseline demographic and clinical characteristics

This table summarizes baseline demographic variables, ASA physical status, surgical procedure, and duration of surgery. All parameters were comparable between the two groups, indicating well-matched study populations.

Table 2. Postoperative NRS pain scores at different time intervals

This table compares postoperative pain scores using the Numerical Rating Scale at predefined intervals. Pain scores were significantly lower in Group P at 2 hours, while scores at other time points were comparable.

Figure 1: Line diagram showing comparison of Numerical Rating Scale (NRS) between the groups

Table 3. Postoperative analgesic outcomes

This table presents postoperative analgesic outcomes. Total tramadol consumption was significantly lower in the PENG group, while duration of analgesia was comparable between groups.

This prospective randomized comparative study evaluated the postoperative analgesic efficacy of the pericapsular nerve group block and the suprainguinal fascia iliaca block in patients undergoing hip surgery. Baseline demographic variables, ASA physical status, type of surgery, and duration of surgery were comparable between groups, ensuring that postoperative outcomes were not influenced by confounding baseline differences.

Postoperative pain assessment using the Numerical Rating Scale showed comparable pain scores in both groups immediately after surgery. A statistically significant reduction in pain scores was observed at 2 hours postoperatively in the PENG group. At later time points up to 24 hours, pain scores remained lower in the PENG group, although the differences were not statistically significant. These findings indicate better early postoperative analgesia with the PENG block.

Similar observations have been reported in previous studies. Choi et al. (5) demonstrated lower postoperative pain scores with the PENG block compared to the suprainguinal fascia iliaca block, particularly during the early postoperative period. Jadon et al. (6) also reported significantly lower NRS scores in the PENG group during the first few postoperative hours, supporting the superior early analgesic effect of this block.

Total postoperative tramadol consumption was significantly lower in the PENG group, indicating a clear opioid-sparing effect. This finding aligns with multiple earlier studies that reported reduced opioid requirements following PENG block. Systematic reviews and randomized trials have consistently shown that PENG block decreases cumulative opioid consumption in the first 24 hours after hip surgery when compared with fascia iliaca block techniques.

The duration of analgesia was longer in the PENG group, although the difference did not reach statistical significance. Similar trends have been reported by Jadon et al. (6) and Zhao et al. (7), who observed a longer time to first rescue analgesia with the PENG block. Variations in local anesthetic concentration, volume, and rescue analgesic protocols may explain differences in statistical significance across studies.

The improved analgesic efficacy of the PENG block can be explained anatomically. The anterior capsule of the hip joint receives dense sensory innervation from the femoral nerve, obturator nerve, and accessory obturator nerve. The PENG block selectively targets these articular branches, providing effective analgesia while sparing motor function. In contrast, the suprainguinal fascia iliaca block produces a broader but less targeted neural blockade, which may account for higher opioid requirements.

Overall, the findings of the present study are consistent with existing literature and reinforce the role of the PENG block as an effective regional analgesic technique for hip surgery. The combination of better early pain control and reduced opioid consumption supports its inclusion in multimodal analgesia protocols.

In conclusion, our comparative study of the Pericapsular Nerve Group (PENG) block and the Suprainguinal Fascia Iliaca Compartment Block (FICB) in patients undergoing hip surgeries demonstrated that the PENG block offers superior postoperative analgesic efficacy.

Patients in the PENG group experienced a significantly lower total tramadol consumption (75 ± 25.43 mg) compared to those in the FICB group (91.66 ± 32.39 mg), indicating a clear opioid-sparing benefit.

The PENG group reported significantly lower NRS scores at 2 hours, highlighting better early pain control. Although pain scores at later intervals were consistently lower in the PENG group, the differences were not statistically significant.

The duration of analgesia was also longer in the PENG group (13.06 ± 2.77 hours vs. 12.13 ± 2.87 hours), suggesting a trend toward prolonged analgesia, though not statistically significant.

Patient satisfaction was markedly higher in the PENG group, with 66.7% reporting high satisfaction compared to 26.7% in the FICB group, a difference that was statistically significant (p = 0.0044). These findings suggest that the PENG block not only provides effective and prolonged pain relief but also improves overall patient satisfaction, making it a more favorable choice for postoperative analgesia in hip surgeries.

Limitations:

Despite the valuable findings of our study, several limitations must be acknowledged.

1. Study was conducted on relatively small sample size which limit the clinical and statistical valid observation.
2. Short term follows up focused on acute post operative pain.
3. In exclusion criteria, patient with comorbidities were excluded hence limiting the applicability of the result to more comorbid populations.
4. Pain was assessed using the Numerical Rating Scale (NRS), which is a validated tool, the subjective nature of pain perception and its reporting can vary greatly among individuals.

Financial Support: Nil
Conflict of Interest: None declared
Ethical Approval: IEC approval obtained (Ref. Letter No.: S No. /IEC/M.C./2023/31040, Rewa Dated 20/12/23).

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