Comparison of the efficiency of the remote approaches for analgesia after total hip arthroplasty

Abstract

Background. Recently, two blocks have been proposed: one of which is the most proximal and is called the erector spinae plane (ESP) block, the other is the most distal and is called pericapsular nerve group (PENG) block. Both techniques are performed under ultrasound control, are positioned as effective and safe, without muscle weakness. The purpose of the work: to evaluate the clinical effectiveness of the most remote approaches (ESP and PENG) for anesthesia in terms of the adequacy of analgesia and physical activity of patients after hip arthroplasty. Materials and methods. The study included 70 ASA II–III patients: 40 women and 30 men with an average age of 64.6 ± 10.7 years who underwent planned primary total hip arthroplasty for disease or fracture under spinal anesthesia. After the surgery, ESP block was performed in group I (n = 35), PENG block in group II (n = 35), 30 ml of 0.25% bupivacaine solution was injected. The ability to cover a distance of 30 meters without time limits, the maximum severity of the pain syndrome, the need for opioids (nalbuphine), the duration of the block and the number of patients with postoperative complications were evaluated. Results. The duration of PENG block was on average 8.6 (5.6–9.8) hours, which statistically significantly exceeded this indicator in patients who received ESP block with an average duration of 5 (3.8–6.0) hours (p < 0.001). With comparable analgesia in both groups, patients who received PENG block required less time to walk the 30-meter distance — 31.0 (27.0–47.0) hours compared to those who received ESP block — 45.0 (32.0–54.0) hours (p = 0.006). In group II, 28.6 % of patients did not need opioids in the postoperative period, and this indicator in group I was only 8.5 % (p = 0.036), demonstrating the better analgesic potential of PENG block. Conclusions. Given the ease of implementation and safety of both regional methods, as well as the effectiveness of PENG block, it appears to be a real alternative to other regional methods in this category of patients.