Hip Surgery, Pericapsular Nerve Group Block (PENG Block), Postoperative Pain Management, Regional Anesthesia
Conditions
Keywords
Hip surgery, postoperative pain, pericapsular nerve group block, analgesia
Brief summary
This retrospective study evaluates the effects of two different administration methods of the Pericapsular Nerve Group (PENG) Block on postoperative pain control, opioid consumption, and recovery in patients undergoing hip surgery. All patients in the study received: * PENG block via a catheter * Patient-Controlled Analgesia (PCA) with tramadol * Multimodal analgesia, including IV paracetamol and nonsteroidal anti inflammatory drugs (NSAIDs) as rescue analgesia The study compares two groups: 1. Intermittent Bolus Group: A researcher administered 20 mL of 0.25% bupivacaine every 4 hours. 2. Continuous Infusion Group: A pump delivered 5 mL/hour of 0.25% bupivacaine continuously. Both groups received the same total volume of local anesthetic over 24 hours. All PENG blocks were performed under ultrasound guidance at the end of surgery. This study aims to determine whether intermittent bolus or continuous infusion PENG block administration leads to better pain control, lower opioid consumption, and improved recovery outcomes.
Detailed description
Postoperative pain management after hip surgery remains a critical factor in recovery quality, opioid consumption, and overall patient outcomes. Among regional anesthesia techniques, the PENG Block is increasingly utilized for pain control due to its ability to provide effective analgesia while minimizing systemic opioid use. However, the optimal administration method of PENG block remains unclear. This retrospective cohort study evaluates the effectiveness of two different PENG block administration techniques in patients undergoing hip surgery: 1. Intermittent Bolus Group: A researcher manually administered 20 mL of 0.25% bupivacaine every 4 hours via a catheter placed under ultrasound guidance at the end of surgery. 2. Continuous Infusion Group: A pump delivered 5 mL/hour of 0.25% bupivacaine continuously via a catheter placed under ultrasound guidance at the end of surgery. Total local anesthetic volume over 24 hours was equal in both groups. Study Objectives: The primary objective is to compare intermittent bolus vs. continuous infusion PENG block administration in terms of: * Postoperative pain control (Visual Analog Scale) (VAS scores) * Total opioid consumption (morphine equivalent) * Time to first rescue analgesia * Quality of recovery (QoR-15 at 24 hours postoperative) Secondary outcomes include: * Postoperative nausea and vomiting (PONV) * Incidence of complications (hematoma, infection, nerve injury) This study aims to provide evidence on whether intermittent bolus or continuous infusion leads to better pain relief, reduced opioid consumption, and improved recovery in hip surgery patients.
Interventions
PROCEDUREIntermittent Bolus PENG Block
Patients received intermittent bolus administration of the Pericapsular Nerve Group (PENG) Block via a catheter. A researcher manually administered 20 mL of 0.25% bupivacaine every 4 hours over a 24-hour period.
PROCEDUREContinuous Infusion PENG Block
Patients received continuous infusion of the Pericapsular Nerve Group (PENG) Block via a catheter. A pump delivered 5 mL/hour of 0.25% bupivacaine continuously over a 24-hour period.
Sponsors
Onur Baran
Namik Kemal University School of Medicine, Tekirdag
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Participants must meet all of the following criteria to be included in the study: 1. Patients who underwent hip surgery between November 15, 2023 - November 15, 2024. 2. Patients who received Pericapsular Nerve Group (PENG) Block via a catheter for postoperative analgesia. 3. Patients who received Patient-Controlled Analgesia (PCA) with tramadol. 4. Patients aged 18 to 65 years. 5. ASA I - III classification. 6. BMI ≤ 35 kg/m².
Exclusion criteria
Participants who meet any of the following criteria will be excluded from the study: 1. Patients who received analgesia with techniques other than PENG block. 2. Patients with incomplete or missing medical records. 3. Patients with a psychiatric illness diagnosis that may interfere with pain perception or reporting. 4. Patients with coagulation disorders (e.g., INR \>1.5, thrombocytopenia). 5. Patients with hepatic or renal failure (Creatinine clearance \<30 mL/min or AST/ALT \>3x normal). 6. Patients with chronic opioid use before surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Scores (VAS) | From 0 hours (postoperatively) to 24 hours postoperatively, assessed at 0, 2, 6, 12, and 24 hours. | Postoperative pain levels will be assessed using the Visual Analog Scale (VAS, 0-10) where: * 0 = No pain * 10 = Worst possible pain * Higher scores indicate worse pain levels. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Postoperative Opioid Consumption | From 0 hours (postoperatively) to 24 hours postoperatively, assessed at 0, 2, 6, 12, and 24 hours. | Total opioid consumption (including PCA tramadol) will be recorded and converted into morphine milligram equivalents (MME) for comparison between groups. |
| Quality of Recovery (QoR-15 Score) | Assessed at 24 hours postoperatively. | The Quality of Recovery-15 (QoR-15) questionnaire will be used to assess the patient's postoperative recovery quality, including physical and emotional well-being. The QoR-15 is a validated tool that measures postoperative recovery across five domains: physical comfort, emotional state, psychological support, physical independence, and pain. Scale Range: 0 to 150 Interpretation: Higher scores indicate better recovery quality. Time Frame: Assessed at 24 hours postoperatively. |
| Postoperative Nausea and Vomiting (PONV) Incidence | From 0 hours (postoperatively) to 24 hours postoperatively. | Incidence of postoperative nausea and vomiting (PONV) will be recorded based on medical chart reviews and antiemetic administration (ondansetron IV use). |
| Time to First Rescue Analgesia | From the end of surgery until the first administration of rescue analgesia, assessed up to 24 hours postoperatively. | The time from surgery completion to the first NSAID rescue analgesia administration (ketorolac or dexketoprofen) will be recorded. |
| Incidence of Complications | From 0 hours (postoperatively) to 24 hours postoperatively. | Any adverse events (hematoma, infection, nerve injury, hemodynamic instability, etc.) will be documented from patient records. |
Countries
Turkey (Türkiye)
Contacts
STUDY_CHAIRCavidan Arar, Prof. Dr.
Medical Faculty of Tekirdağ Namık Kemal University
Outcome results
None listed