Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial

Abstract

Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.

Keywords: analgesia; anesthesia; nerve block; postoperative pain; regional anesthesia; total hip arthroplasty.

Figure 1

CONSORT flow diagram. CONSORT indicates Consolidated Standards of Reporting Trials.

Figure 2

Regional Anesthesia Techniques: (A) Lateral femoral cutaneous nerve (LFCN) block. Green dashed line: LFCN; TFLM: tensor fasciae latae muscle; SM: sartorius muscle (B) PENG Block: IPT: iliopsoas tendon; IPE: iliopubic eminence; asterisk (green *): injection target; FA: femoral artery; IPM: iliopsoas muscle; AIIS: anterior inferior iliac spine.

Figure 3

Static postoperative pain. The box plot shows postoperative pain scores in both study groups. Data include static pain reported at three different postoperative time points (6, 12 and 24 h). Pain severity is expressed using a 0–10 numeric rating scale, with 0 equal to no pain and 10 being the worst imaginable pain. Values are expressed as median (horizontal bars) with 25th–75th (box) and range of minimum to maximum value (whiskers); * denotes statistical significance (p < 0.05). PENG: pericapsular nerve group block; WI: wound infiltration; LFCN: lateral femoral cutaneous nerve block; s-NRS: numeric rating scale at rest (static).

Figure 4

Dynamic postoperative pain. The box plot shows postoperative pain scores in both study groups. Data include dynamic pain reported at three different postoperative time points (6, 12 and 24 h). Pain severity is expressed using a 0–10 numeric rating scale, with 0 equal to no pain and 10 being the worst imaginable pain. Values are expressed as median (horizontal bars) with 25th–75th (box) and range of minimum to maximum value (whiskers); * denotes statistical significance (p < 0.05). PENG: pericapsular nerve group block; WI: wound infiltration. LFCN: lateral femoral cutaneous nerve block; d-NRS: numeric rating scale on movement (dynamic).