Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery

Background

Effective perioperative pain control in elderly patients undergoing hip fracture surgery remains a challenge due to the adverse effects of opioids and limitations of conventional nerve blocks. The ultrasound-guided pericapsular nerve group (PENG) block offers targeted analgesia with minimal motor blockade, supporting early mobilization. This study evaluates the analgesic efficacy of 0.5% levobupivacaine alone versus in combination with dexamethasone for PENG block.

Methods

In this prospective, randomized, double-blinded controlled trial, 44 adult patients scheduled for elective hip fracture surgery under spinal anesthesia were allocated into two equal groups. Group L received 20 mL of 0.5% levobupivacaine, while group LD received the same volume with 8 mg of dexamethasone. The primary outcome was the time to first rescue analgesia. Secondary outcomes included Numerical Rating Scale (NRS) scores at rest and movement, total opioid consumption in the first 48 hours postoperatively, ease of positioning for spinal anesthesia, hemodynamic stability, and anesthesiologist satisfaction.

Results

A total of 50 patients were assessed for eligibility, with 44 meeting the inclusion criteria and randomized equally into two groups (group L: 22; group LD: 22). The per-protocol analysis included 42 patients (21 in each group). Demographic characteristics were comparable between the groups. Group LD demonstrated a significantly prolonged time to first rescue analgesia (15.00 ± 2.67 hours) and second rescue analgesia (25.50 ± 3.73 hours) compared to group L (6.38 ± 1.24 hours and 12.29 ± 2.80 hours, respectively; p < 0.001). Pain scores were consistently lower at rest and during movement in the dexamethasone group at all postoperative intervals. Total opioid consumption was significantly reduced in group LD. Anesthesiologist satisfaction scores were significantly higher in group LD (p = 0.013). Side effect profiles were similar, with only one patient in Group L experiencing nausea. Both groups had comparable Ease of Spinal Positioning scores and showed no occurrence of motor blockade. Ambulation was not significantly different between the groups (p = 1.000).

Conclusion

The addition of dexamethasone to levobupivacaine in PENG block significantly enhances postoperative analgesia, facilitates patient positioning, reduces opioid requirements, and improves overall satisfaction without compromising safety. This combination may be considered a superior analgesic strategy in elderly patients undergoing hip surgery.