Post- operative analgesia and opioid- sparing efficacy of ultrasound- guided pericapsular nerve group (peng) block versus quadratus lumborum block (qlb) in proximal femur fracture patients: a comparative study

Abstract

BACKGROUND AND AIMS: Hip arthroplasty is frequently associated with significant postoperative pain, which can delay mobilization and recovery. Effective pain management is essential for early rehabilitation, improved functional outcomes, and reduced complications in proximal femur fracture surgeries. Regional anaesthesia techniques, such as the Pericapsular Nerve Group (PENG) block and Quadratus Lumborum Block (QLB), have gained prominence for their ability to provide targeted analgesia while minimizing opioid use. The PENG block selectively targets articular branches of the lumbar plexus, preserving quadriceps strength and enabling early mobilization, whereas the QLB offers broader analgesia with variable motor involvement. Despite their growing use, comparative data on these techniques in hip arthroplasty are limited. This study aimed to evaluate and compare the analgesic efficacy, opioid sparing effects, quadriceps strength preservation, and safety of the PENG and QLB techniques to optimize postoperative pain management strategies. METHODOLOGY: • Written informed consent obtained. • Nil by mouth status confirmed. • IV access was secured 20 Gauge cannula. • Patients underwent thorough pre anaesthetic evaluation with detailed history, airway examination, systemic examination. Patient was explained about the study procedure and sensitized about Visual analogue scale. Routine blood investigations were done. • PENG block was given in group P with 20 ml of 0.25% bupivacaine and Docusign Envelope ID: 569820DB-AF0E-4FB6-8AC2-3B5AF5BCB32A dexamethasone, QL block with 20 ml of 0.25% bupivacaine and dexamethasone in group Q and no block given in group C followed by spinal anaesthesia was given using 2 mL of 0.5% Bupivacaine combined with 25 mcg Fentanyl. RESULTS: - • The demographic parameters, including age and gender, were comparable across all groups, showing no significant differences. • Pain scores (VAS) were significantly lower in the PENG group compared to the QLB and control groups, particularly during the early postoperative period. • The time to first rescue analgesia was significantly longer in the PENG group, and opioid consumption was lower in both block groups compared to the control group, with the PENG group showing the greatest opioid-sparing effect. • Quadriceps strength was better preserved in the PENG group, while the QLB group showed moderate preservation, and the control group had the least preservation. CONCLUSION: - In conclusion, the PENG block demonstrated superior efficacy in postoperative pain relief, opioid-sparing effects, and preservation of quadriceps strength compared to the QLB and control groups, facilitating early mobilization and faster recovery. The QLB provided effective pain relief and moderate preservation of quadriceps strength, though less consistent than the PENG block. Both regional techniques were safe, with no significant adverse events observed, emphasizing their utility in optimizing pain management for proximal femur fracture surgeries.