Comparing the efficacy of Pericapsular nerve group block (PENG) block versus Supra-inguinal fascia iliaca block (FIB) in Total Hip Arthroplasty : A prospective randomized control trial.

The current modalities for pain control often rely on multimodal analgesia. Opioids remain an integral part of most analgesic plans either via intravenous boluses, infusion or patient controlled analgesia (PCA) pumps. Using opioids alone intensifies their side-effect profile that includes, postoperative nausea and vomiting (PONV), sedation, pruritus and respiratory depression.The common opioid sparing methods are use of non-steroidal anti inflammatory drugs (NSAIDs), spinal opioids, epidural postoperative analgesia and peripheral nerve blockade3.Peripheral nerve blockade has started gaining attention in the recent past for arthroplasty. Although its place is well recognized in knee arthroplasty its place in hip arthroplasty is not well defined. The modified supra inguinal approach of FIB described by Stevens places the local anaesthetic (LA) solution in the fascia iliaca plane higher up than the conventional technique and thus allow more superior spread of  (LAs) and hence blockade of nerves derived from L1 and L2 anterior rami of lumbar plexus (ilioinguinal, iliohypogastric and genitofemoral) leading to more effective pain relif. 5We The anterior capsule is the most richly innervated section of the joint suggesting these nerves should be the main targets for hip analgesia. A recent anatomical study by Short et al15 confirmed the innervation of the anterior hip by these 3 main nerves but also found that the AON and FN play a greater role in the anterior hip innervation than previously reported. The hypothesis of this study is that a PENG block will provide a better postoperative analgesia and reduce opioid consumption in the postoperative period in patients undergoing THR.