A Randomized Comparative Study Of Ropivacaine Vs Ropivacaine With Dexamethasone In Ultrasound Guided Pericapsular Nerve Group Block For Preoperative and Postoperative Analgesia In Patients Undergoing Elective Hip Surgery SMS Medical College, Jaipur..

Hip fractures are common orthopedic problems associated with significant morbidity and

mortality. As a definitive treatment, most patients with fractured hips would undergo early

reduction and surgical fixation (1). The majority of hip fractures in the elderly population

results from an inadvertent fall, whereas, it is more commonly caused due to a high energy

trauma in the younger and adult population (2). Irrespective of the etiology, hip fractures are a

painful condition, and early pain relief and definitive management is of utmost importance,

especially in the elderly population.

Hip surgery is often accompanied by severe pain-induced postoperative adverse effects, such

as enhanced blood pressure, delayed mobility, delirium, and deep vein thrombosis. As a

result, patients require large opioid doses for pain relief, which, in turn, induce drug-related

complications like nausea, vomiting, itching, and respiratory inhibition, which are not

conducive to patient recovery. (3)

Central neuraxial blockade is the most common anaesthetic technique for hip surgical

procedures. Patients with hip fracture experience excruciating pain, which would prevent the

ideal positioning of the patient for the neuraxial blockade . (4) There is growing interest in using

regional nerve blocks for pain reduction in the elderly with fractured hip. Femoral nerve

block (FN), Fascia Iliaca block (FIB), and 3-in-1 FN block were formerly used to treat hip

fractures. These blocks provided perioperative analgesia and reduced the patient’s

postoperative opioid requirement . (5) Although FNB and FICB provides adequate analgesia for

patients, it has certain limitations, such as incomplete block and lower limb muscle weakness.

The anterior capsule of the hip joint is mainly supplied by branches of the femoral nerve

(FN), obturator nerve (ON), and accessory obturator nerve (AON). Literature suggests that

the obturator nerve is not covered in these blocks. The core of hip analgesia is the anterior

capsule, and FN, ON, and AON are the keys to block (6) PENG, a new regional block

technique introduced by Girón Arango et al. (7) in 2018.Available evidence suggests that the

PENG block has shown some promise in cases undergoing hip surgery . (8) We have planned

this study to compare the pre operative and post operative analgesic efficacy of USG guided

PENG block with Ropivacaine vs Ropivacaine with Dexamethasone for elective hip surgery.