PENG vs Intra-articular Injection for Hip Arthroscopy (PARİAH)

Pericapsular Nerve Group (PENG) Block Versus Intra-articular Injection for Hip Arthroscopy: A Randomized Trial

Hip arthroscopy is a popular surgical method that is increasingly being used for both intraarticular and extraarticular hip surgeries. Postoperative acute pain is difficult to control in hip surgeries due to the complex nature of hip innervation and the large number of surgical interventions. Optimal treatment of postoperative pain in hip arthroscopy is very important to be able to perform rehabilitation, avoid opioid side effects and minimize unplanned re-hospitalization. Regional anesthesia techniques are widely used because of their proven efficacy in post-surgical pain management and their safety profile that ultimately contributes to early recovery. Many regional techniques such as neuraxial blocks, lumbar plexus block, femoral nerve block, fascia iliac block and intraarticular local anesthetic injection have been used for the treatment of acute postoperative pain. Femoral nerve and fascia iliac blocks have shown good results for long-term post-surgery analgesia. However, the obturator nerve and accessory obturator nerve should be targeted to achieve more effective perioperative pain control. There are studies reporting that pericapsular nerve group block (PENG), which has been defined in recent years, provides effective perioperative analgesia in hip surgeries. In this study, we aim to compare the effectiveness of PENG block and intra-articular local anesthetic injection in hip arthroscopy.

Injection of 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml isotonic saline mixture between iliopubic eminentia and psoas tendon under ultrasound guidance

At the end of the surgical case, a total of 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml isotonic saline injection intra-articularly.

PENG block will be made with 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml NaCl under US-guidance

Intra-articular local anesthetic injection will be made with 10 ml 0.5% bupivacaine + 2 mg dexamethasone + 9.5 ml NaCl

Total amount of morphine consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted.

Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be ) at 0.5, 1, 3, 6, 12, 24 hours postoperatively.

Nausea and vomiting intensity score measured by numeric rank score (0:no nausea and no vomiting, 1: have nausea, no vomiting, 2: once vomiting, 3: two or more vomiting).

Patient satisfaction measured using a numeric rating scale 0 to 10 (0 = unsatisfied; 10 =very satisfied)

Inclusion Criteria: American Association of Anesthesiologists (ASA) physical status I - III BMI 20 to 35 kg / m2 Patients scheduled for elective hip arthroscopy Able to provide informed consent. Exclusion Criteria: Patients who refuse to participate in the study, Coagulopathy, Sepsis, Hepatic or renal insufficiency, Pregnancy Allergy to local anesthetic drugs, Chronic pain condition requiring opioid intake at home, BMI above 40. History of psychiatric diseases needing treatment. Failure of nerve block Substance abuse history Hip revision surgery Underlying neurologic disorder affecting pain perception. Angina, heart attack, heart failure Kidney or hepatic insufficiency Stroke Gastrintestinal bleeding history