Comparison of ultrasound-guided suprainguinal fascia iliaca compartment block and pericapsular nerve group block for postoperative analgesia and associated cognitive dysfunction following hip and proximal femur surgery.

Abstract

Hip and proximal femur fractures in any age group require surgical reduction and fixation. Various regional techniques are popular for lower limb surgeries but adequate analgesia from these blocks is variable depending upon the type of surgery. We conducted a study to compare ultrasound-guided suprainguinal fascia iliaca compartment (SFIC) block and pericapsular nerve group (PENG) block for postoperative analgesia and cognitive dysfunction in patients undergoing hip and proximal femur surgery. Sixty-six patients, aged 18-65 years, American Society of Anaesthesiologists I and II undergoing hip and proximal femur surgery were randomized into two groups, group F for SFIC block (n = 33) and group P for PENG block (n = 33). After completion of surgery, an ultrasound-guided SFIC or PENG block was given. Visual analogue scale (VAS) score on movement and rest, muscle power (quadriceps strength), time to first rescue analgesia, total analgesic requirement, and postoperative cognitive dysfunction in the first 24 h were observed. A total of 66 patients participated in the study and 30 in each group were analyzed. VAS score at movement was significantly lower (P = 0.018) with better quadriceps muscle strength (P = 0.001) in the PENG block compared to the SFIC block group at 24 h postoperatively. Total opioid consumption in morphine equivalents (P = 0.03) was lower in the PENG block than in the SFIC block group for 24 h (28.5% vs. 71.4%). Cognitive impairment was comparable in both groups (3.3% vs. 16.7%, P = 0.097). PENG block is better than SFIC block for postoperative analgesia with lesser opioid consumption, whereas postoperative cognitive dysfunction was comparable in both groups.