Ultrasound-guided caudal epidural Versus PENG Block as a part of the opioid-sparing multimodal analgesic regime for pediatric open hip surgery: A comparative prospective Randomized Clinical Trial

Management of postoperative pain after open hip joint surgery in the pediatric population is often challenging, necessitating the use of systemic opioids.[1]Globally, opioid-sparing strategies and enhanced recovery after surgery programs are making their appearance in pediatric surgical specialties.[2]Regional anesthesia and a robust plan for multimodal analgesia are the primary methods being used to decrease opioid use.[3, 4]

The most frequently used method of regional analgesia in pediatric hip surgery is caudal epidural blocks.[5] However, it is known to be associated with numerous adverse effects like bilateral motor blockade, hypotension, and accidental dural puncture.[6] Regional blocks such as Pericapsullar nerve group (PENG) block in adjuvant with general anesthesia is an alternative perioperative analgesic technique and have been reported in many case series to cause unilateral sensory blockade with an excellent safety profile in pediatric surgical patients.[7] The Pericapsullar nerve group (PENG) block is a novel motor-sparing regional anesthetic technique where the local anesthetic agent is deposited in the musculofascial plane between the psoas tendon and the pubic ramus. The main target is the genicular branches of the femoral, obturator, and accessory obturator nerve, which innervate the hip capsule.[8]

However, pediatric peripheral RA lags behind adult practice in the type of RA offered and the percentage of cases performed with a regional technique among eligible patients. No prospective randomized trials compare the analgesic efficacy of PENG block with the traditional caudal epidural block in pediatric patients.

This study is carried out to assess ultrasound-guided PENG block versus caudal block for its analgesic efficacy, opioid-sparing effects, and safety in pediatric hip surgery. The primary objective is to evaluate the postoperative pain scores in the first 24 hours after surgery in patients undergoing hip surgery receiving either PENG or caudal epidural block. The secondary objectives include time to first request opioid analgesics, total opioid consumption in 24 hours, adverse effects, and parents’ satisfaction. We hypothesize that the PENG blocks could offer superior perioperative analgesia compared to caudal epidural for hip surgery in children.