EFFECTIVENESS OF PERICAPSULAR NERVE GROUP BLOCK IN PROXIMAL FEMORAL FRACTURES

Introduction. Currently, a multimodal approach is used for adequate pain relief, which includes regional analgesia methods in the perioperative pain relief plan, contributing to early activation and reduction of postoperative complications. Aim. Comparison of the effectiveness of pericapsular nerve block and femoral nerve block in patients operated under spinal anesthesia for proximal femur fractures in the perioperative period. Materials and Methods. Depending on the regional analgesia method used, 60 adult patients were randomized into two groups: PENG (n = 30), where pericapsular nerve block was performed, and FNB (n = 30) with femoral nerve block. In the PENG group, pericapsular nerve block was performed under ultrasound navigation with 15-20 ml of 0.5% bupivacaine solution in combination with 4 mg of dexamethasone as an adjuvant to the local anesthetic. In the FNB group, femoral nerve block was performed in a similar manner. The primary endpoint of the study was pain intensity according to a ten-point numeric rating scale during the first day after surgery. Secondary endpoints included consumption of opioid analgesics on the first postoperative day, strength of the anterior thigh muscle groups, angle of a comfortable independent patient’s seat for performing neuraxial anesthesia in the perioperative period, and duration of the block in minutes. Data were analyzed using SPSS software, a p value of <0.05 was taken as statistically significant. Results and Discussion. According to a numeric rating scale, the pain intensity was, on average, 50% lower in the PENG group compared to the FNB group (p<0.05). Blockade of the pericapsular nerve groups caused two times less weakness of the anterior thigh muscle groups, and this made it possible to activate three times more patients in the early postoperative period than with the femoral nerve block. Total opioid analgesic consumption was 40% lower in the PENG group (p < 0.05), potentially reducing their side effects. When positioning patients, 27 patients in the PENG group completed it, which was 90%, and 16 patients (53.3%) in the FNB group; this was almost 37% lower than in the PENG group. The duration of the pericapsular nerve block action was 40% longer than that of the femoral nerve block. Conclusions. Pericapsular nerve block significantly reduces pain, provides less need for opiates, and causes less anterior muscle weakness than femoral nerve blocks, which promotes early mobilization of patients with proximal femoral fractures.