Impact of Different Volumes of Pericapsular Nerve Group Block on Pain During Spinal Anesthesia Positioning and Postoperative Opioid Requirements in Femoral Fracture Surgeries; Randomized Prospective Study

Gamze Ertaş,1 Hamiyet Şenol Çakmak,1 Sevda Akdeniz,1 Alparslan Yurtbay,2 Ebru Polat,2 Yavuz Yigit,3,4 Nezih Sertöz,5 Serkan Tulgar1 1Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkiye; 2Department of Orthopedic Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkiye; 3Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; 4Blizard Institute, Queen Mary University, London, UK; 5Department of Anesthesiology and Reanimation, Ege University, Faculty of Medicine, İzmir, TurkiyeCorrespondence: Yavuz Yigit, Hamad Medical Corporation,Hamad General Hospital, Department of Emergency Medicine, Hamad General Hospital, Emergency Department, Doha, 3050, Qatar, Tel +97430616054, Email [email protected]: Hip fracture surgeries in patients present significant challenges, particularly in managing pain during spinal anesthesia positioning. The Pericapsular Nerve Group Block (PENG) has shown promise in addressing this issue, but the ideal volume of local anesthetic for PENG is still uncertain. In our study, we aimed to analyze the effects of administering PENG block with two different volumes on analgesic quality for patients undergoing hip fracture surgery.Methods: In this prospective, randomized controlled trial, the effects of administering a PENG block with 20 mL versus 30 mL of local anesthetic in patients undergoing hip fracture surgery under spinal anesthesia were compared. The primary outcome was pain during spinal anesthesia positioning, and secondary outcomes included postoperative pain scores and opioid consumption.Results: A total of 60 patients were analyzed, with 30 in each group. Critical parameters such as the time of spinal anesthesia administration and the satisfaction of the anesthesiologist showed no significant differences (p=0.918; p=0.741, respectively). NRS scores recorded before, during, and after the positioning for spinal anesthesia exhibited similar patterns (p=0.290; p=0.247; p=0.288, respectively). The cumulative opioid requirements did not exhibit a statistically significant difference at 24 hours (p = 0.098). Quadriceps weakness was significantly more in the PENG-30 group 6 hours after surgery but had recovered by the 9th hour (p= 0.004).Conclusion: In patients undergoing hip fracture surgery, the effects of applying the PENG block with 20 mL or 30 mL of local anesthetic are comparable in terms of positioning for spinal anesthesia and postoperative analgesic requirements.Keywords: hip fracture surgery, pericapsular nerve group block, PENG, spinal anesthesia positioning, postoperative analgesia, local anesthetic volume