Background: While multimodal non-opioid analgesia may help reduce opioid-related side effects, opioid use can still lead to dose-dependent tolerance, dependence, and addiction in some patients, impacting maternal satisfaction. This limitation has sparked interest in opioid-free multimodal analgesia, which combines non-opioid and adjuvant analgesics on a scheduled basis, reserving opioids for rescue analgesia only. Magnesium sulfate, an adjuvant analgesic, is a suitable component of opioid-free analgesia, particularly for preeclamptic women on magnesium sulfate undergoing caesarean section, as it may contribute to improved maternal satisfaction and outcomes. Aim: To determine and compare maternal satisfaction in opioid-free analgesia treated preeclamptic women and opioid-based analgesia treated preeclamptic women undergoing caesarean section. Methods: Ethical approval was obtained from the research ethics committee of Federal Medical Centre, Yenagoa. The study was a superiority randomized clinical trial. One hundred preeclamptic women undergoing caesarean section who gave consent and met the eligibility criteria was enrolled into the study. Sampling method was convenience sampling. Randomization was carried out by using WINPEPI. There were two groups with 50 participants in group A (experimental arm) and 50 participants in group B (control arm). Experimental arm received postoperative intravenous paracetamol, intramuscular placebo and rectal diclofenac for 24 hours. Control arm received postoperative intramuscular pentazocine, intravenous paracetamol and rectal diclofenac for 24 hours. Rescue analgesia (intramuscular pethidine) was administered to women in this study outside the established analgesic regimen for both arms of the study if needed. A Likert scale was used to assess maternal satisfaction 24 hours post-surgery. Statistical significance was pValue <0.05. Results: Patients in the treatment arm B reported less severe pain (0% vs. 38%), greater satisfaction with pain relief (68% vs. 28%), and a higher likelihood of recommending the treatment (68% vs. 44%). Fewer patients in the treatment arm B rated their satisfaction as poor or very poor (12% vs. 34%), and more rated it as excellent (34% vs. 0%). However, dissatisfaction with pain relief methods was prevalent in both groups (92% vs. 98%). Statistical significance was observed in pain experience (0% vs. 38%), satisfaction (28% vs. 68%), and perceived effectiveness (0% vs. 34%). Conclusion: While opioid-based multimodal analgesia provided significantly better pain relief and higher maternal satisfaction, opioid-free multimodal analgesia remained a viable and acceptable alternative for postoperative pain management in preeclamptic women receiving magnesium sulphate after caesarean section.

Objective This study aims to investigate the impact of dexmedetomidine combined with ropivacaine scalp nerve block (SNB) on analgesic effects in patients undergoing craniotomy for hypertensive intracerebral hemorrhage (HICH). Methods A prospective randomized controlled trial was conducted on 120 HICH patients who underwent craniotomy at Longyan First Affiliated Hospital of Fujian Medical University from May 2022 to April 2024. Patients were randomly divided into three groups: control group (A, no SNB), ropivacaine SNB group (B, 0.5% ropivacaine), and dexmedetomidine-ropivacaine SNB group (C, 0.5% ropivacaine + 0.5 μg/kg dexmedetomidine), with 40 patients in each group. Primary outcomes included intraoperative hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR)], intraoperative anesthetic consumption, postoperative Visual Analogue Scale (VAS) scores, rescue analgesia requirements, and incidence of adverse reactions within 48 h postoperatively. Results General characteristics were comparable among the three groups ( p > 0.05). Compared with Group A, Groups B and C showed more stable intraoperative MAP and HR ( p < 0.05), lower VAS scores at 6, 12, 24, and 48 h postoperatively ( p < 0.01), reduced consumption of propofol and remifentanil ( p < 0.01), delayed first rescue analgesia ( p < 0.01), fewer rescue analgesia administrations ( p < 0.01), and lower incidences of nausea/vomiting and postoperative agitation ( p < 0.05). Group C exhibited superior outcomes to Group B in VAS scores (6, 12, 24, and 48 h), anesthetic consumption, and rescue analgesia metrics ( p < 0.05), with no significant difference in adverse reactions ( p > 0.05). Conclusion Dexmedetomidine combined with ropivacaine for SNB improves postoperative analgesia, stabilizes intraoperative hemodynamics, reduces anesthetic usage and rescue analgesia needs, and lowers the incidence of adverse reactions in HICH craniotomy patients, making it a safe and effective analgesic strategy. Clinical trial registration chictr.org.cn , identifier ChiCTR2500106043.

BackgroundPercutaneous vertebroplasty (PVP) often causes moderate-to-severe intraoperative pain, with current local anesthesia methods providing limited relief. The erector spinae plane block (ESPB) has shown promise in regional analgesia but lacks evidence for PVP. This study aims to test the hypothesis that a preoperative bilateral ESPB provides superior intraoperative analgesia compared to local anesthetic infiltration alone in patients undergoing lumbar PVP. The primary objective is to compare the incidence of moderate-to-severe pain between the two groups.MethodsThis single-center, randomized, single-blind, parallel-group trial will enroll 66 patients undergoing lumbar PVP, who will be randomized to ESPB (20 mL 0.25% ropivacaine bilaterally) or local anesthesia (1% lidocaine). Primary outcome: incidence of moderate-to-severe pain (VAS > 3). Secondary outcomes will include maximum pain scores, patient/surgeon satisfaction, rescue analgesia, time to first mobilization, incidence of adverse events, anesthesia preparation time, and total operating-room occupancy time.DiscussionThe study aims to validate ESPB’s efficacy in PVP, potentially reducing opioid use and improving recovery. Strengths include CONSORT adherence and pragmatic outcomes, though single-center design and limited follow-up may affect generalizability.ConclusionThis trial will determine whether ESPB offers superior analgesia for PVP, guiding future pain management strategies. If proven effective, ESPB could be adopted as a key component of multimodal analgesia for vertebral augmentation, potentially leading to reduced opioid dependence, improved patient comfort, and faster recovery. The results will guide future evidence-based pain management strategies for these common procedures.

Effective postoperative pain control is essential in ambulatory hernia surgery. This pilot randomized controlled trial aimed to evaluate the efficacy, safety, and feasibility of topical EMLA (eutectic mixture of local anesthetics) cream as adjunct postoperative analgesia following open inguinal hernioplasty under local anesthesia. A prospective, double-blind, randomized controlled trial was conducted at Hospital Canselor Tuanku Muhriz, UKM, from December 2023 to March 2025. Thirty-six male patients undergoing elective open inguinal hernia repair under local anesthesia were randomized to receive either EMLA (n=18) or placebo cream (n=18). The cream was applied topically to the surgical site every 6h for 48h. Pain was self-assessed using a numerical rating scale (NRS) after each application. Primary outcomes included pain scores and rescue analgesia use; secondary outcomes included feasibility and adverse events. Topical application was rated "easy" or "very easy" by all participants, with no adverse events or complications reported. In the EMLA group, pain scores significantly decreased across all post-application time points compared to baseline (p<0.05), whereas no significant changes were observed in the placebo group. Between-group analysis showed significantly lower pain scores in the EMLA group starting from 6h postoperatively (p<0.001). No participants in either group required rescue analgesia. Topical EMLA cream is a feasible adjunct for postoperative pain control following open inguinal hernia repair under local anesthesia. Although no infections or adverse events occurred in this pilot cohort, the study is underpowered to detect rare complications such as surgical site infection; therefore, safety conclusions should be interpreted with caution. The clinically meaningful reduction of 2-3 points in pain scores supports further validation in larger, adequately powered trials using an inert placebo.

Advances in minimally invasive techniques, enhanced recovery protocols, and regional pain management have improved postoperative outcomes. However, visceral pain and postoperative nausea and vomiting (PONV) continue to be challenging after minimally invasive procedures. Intraoperative autonomic neural blockade (ANB), which interrupts the afferent nerves transmitting these impulses, has effectively addressed these challenges, as demonstrated in previous publications. This randomized trial evaluates its efficacy in laparoscopic cholecystectomy. In this double-blind, randomized controlled trial, 62 patients undergoing elective laparoscopic cholecystectomy were assigned to receive ANB with Bupivacaine and Dexamethasone (intervention group) or no blockade (control group). All patients received standard TAP, subcostal blocks, low-pressure pneumoperitoneum, and ERAS-based care. The primary outcome was Acetaminophen consumption. Rescue analgesic use was assessed at 1, 24, and 48h postoperatively. Secondary outcomes included pain scores at 1, 24, and 48h and the incidence of nausea and vomiting. Baseline characteristics were similar between groups. Pain scores were significantly lower in the ANB group at 1, 24, and 48 h (0.42 vs. 2.52 at 1h; p < 0.0001). Acetaminophen consumption was markedly reduced over 48 h (0.42 vs. 2.33 doses; p < 0.0001). Fewer patients required NSAIDs or Codeine rescue analgesia, and nausea/vomiting was less frequent in the ANB group. No adverse events were reported. This study demonstrates that ANB significantly reduces the analgesic requirements and autonomic symptoms after laparoscopic cholecystectomy, even when added to comprehensive multimodal care. These findings support its broader use in minimally invasive surgery (MIS), where autonomic afferent input predominates by targeting the appropriate pathways.

Hip arthroplasty is a frequently performed surgery that requires effective multimodal analgesia for optimal recovery and adherence to enhanced recovery after surgery protocols. Traditionally, spinal anesthesia with opioids has been the mainstay for postoperative pain management, but side effects have prompted increased use of peripheral nerve blocks. The fascia iliaca block (FIB) is a well-established technique recommended by PROSPECT guidelines, while the erector spinae plane block (ESPB) has recently emerged as a potential alternative. This systematic review and meta-analysis aimed to compare the efficacy of FIB and ESPB in patients undergoing hip arthroplasty. A comprehensive search of PubMed, Cochrane, and Embase identified six randomized controlled trials (RCTs) including 348 patients, evenly distributed between ESPB and FIB groups. Primary outcomes included incidence of motor block, cumulative opioid consumption, time to first rescue analgesia, and postoperative pain scores. The analysis revealed that ESPB significantly reduced the incidence of quadriceps motor block compared to FIB, with a relative risk (RR) of 0.25 (95% CI, 0.13-0.49; P<0.001). Motor block occurred in 8.7% of ESPB patients versus 38.4% of FIB patients. However, there were no statistically significant differences between groups in 24-hour cumulative opioid consumption, time to first rescue analgesia, or pain scores at rest or during movement. ESPB offers a clear advantage over FIB in preserving motor function without compromising analgesic efficacy. These findings support ESPB as a viable alternative to FIB in hip arthroplasty pain management protocols.

To compare surgical time, incision length, intraoperative bleeding, and post-operative pain in cats undergoing three different ovariectomy techniques: open surgery with pedicle ligation using sutures, open surgery using a bipolar vessel-sealing device, and a two-port laparoscopic approach. A prospective randomized clinical trial was conducted on 27 healthy female cats assigned to three treatment groups (n = 9 per group). Surgical variables were recorded intraoperatively, and post-operative pain was assessed using a validated feline pain scale at hourly intervals over four hours. The laparoscopic group had the shortest incision length (mean 10.0mm, SD 0.0) compared to the suture (mean 33.3mm, SD 5.6) and bipolar device groups (mean 28.7mm, SD 6.4). Surgical time was significantly shorter in the BVSD (27.0 ± 9.6min) and LOVE groups (30.2 ± 5.2min) compared with the Suture group (43.9 ± 14.4min; one-way ANOVA, p = 0.005; Tukey post-hoc p < 0.05 vs. Suture for both comparisons). Post-operative pain scores at one hour (T1) were lower in the LOVE group (median 4 [IQR 3-5]) than in both open groups (Suture: 9 [IQR 8-9]; BVSD: 7 [IQR 6-8]; Kruskal-Wallis, p = 0.014; Dunn's post-hoc p < 0.05 vs. BVSD and trend towards lower scores vs. Suture). Only 1 of 9 cats requiring rescue analgesia versus 7 of 9 in each open group. The laparoscopic approach was associated with lower post-operative pain scores and a reduced need for rescue analgesia compared to open ovariectomy techniques, suggesting improved perioperative comfort. Although the laparoscopic group showed a significantly shorter surgical time compared with the suture group, this observation should be interpreted cautiously due to potential operator- and case-dependent variability. Nevertheless, laparoscopic ovariectomy in cats should be considered a promising and welfare-oriented technique that warrants further investigation.

Spinal anesthesia (SA) is preferred for hip fracture surgery but can be difficult due to severe preoperative pain. This study compared prespinal analgesic techniques for improving theease ofSA and postoperative analgesia in neck offemur fractures. In aprospective, randomized, double-blind trial, 210 patients aged ≥ 60 years undergoing internal fixation offractured neck offemur under SA were allocated to three groups. Group Areceived afemoral nerve block (FNB), Group B apericapsular nerve group (PENG) block, and Group C intravenous fentanyl 1 µg kg-1 10 minutes before SA. For FNB and PENG, 20 mL of0.25% bupivacaine was used. ThePENG group had thelowest Ease ofSpinal Anesthesia (EOSA) score (median 7 [IQR 7-8]) vs. FNB 8 (7-9) and fentanyl 9 (9-10) (P < 0.001). Pain during positioning and puncture was lowest with PENG (P < 0.001). Time to first rescue analgesia was longest with PENG (8.8 ± 2.03 h, 95% CI: 8.3-9.3) compared with FNB (5.9 ± 1.5 h, 95% CI: 5.5-6.4) and fentanyl (4.2 ± 0.7 h, 95% CI: 4.0-4.4) (P < 0.001). Immediate postoperative visual analog scale (VAS) scores at 6 and 12 hours were lower with PENG; differences at 24 hours and 30 days were not significant. Hemodynamics and complication rates were largely similar across groups. In hip-fracture patients, ultrasound-guided PENG and FNB improved theease ofSA and reduced postoperative opioid use, with PENG showing thegreatest benefit.

Hip fractures are common in older adults and are associated with increased morbidity and mortality. Although multimodal anesthesia with peripheral nerve blocks is recommended, the superiority of specific block methods remains unclear. This study compared the postoperative analgesic efficacy of the suprainguinal fascia iliaca block (SFIB) and lumbar erector spinae plane block (LESPB) in patients who underwent hip fracture surgery. This single-center, single-blind, randomized controlled trial was conducted at a university hospital (Marmara University Faculty of Medicine, İstanbul, Türkiye) between August 2022 and May 2023. Patients received SFIB, LESPB, or no block before spinal anesthesia. No block-related complications were observed. Postoperative analgesia was provided using patient-controlled intravenous morphine, with tramadol administered as rescue analgesia for NRS pain scores above 4. The primary outcome was 24-hour total opioid consumption. Secondary outcomes included opioid consumption at 6 and 48 hours, pain scores, rescue analgesia requirements, and time to discharge from the intensive care unit and hospital. A total of 63 patients (mean age 78.5±14.0 years; 46 females and 17 males) with American Society of Anesthesiologists I-III undergoing hip fracture surgery were randomized to SFIB (n=23), LESPB (n=22), or control (n=22). During the first 24 hours, opioid consumption were higher in the control group [18 (9-24.5); p=0.002]. Post-hoc analysis showed a significant difference between the control and SFIB groups [6 (4-9); p<0.001]. The LESPB [13 (5-22)] and control groups were comparable (p>0.016). SFIB provided the greatest reduction in postoperative opioid use during the first 24 hours after hip fracture surgery. While LESPB appears to be an alternative to SFIB, it produced a reduction in opioid consumption similar to that observed in the control group. Suprainguinal FIB should be prioritized as a component of multimodal analgesia for these surgeries.

A BSTRACT Background: Proper pain control before subarachnoid block (SAB) is must in proximal femur fractures as patients cannot tolerate movement due to severe pain. This study compares ultrasound-guided fascia iliaca compartment block (USG-FICB) with femoral nerve block (USG-FNB) for pre-SAB analgesia. Materials and Methods: Ninety patients scheduled for elective femur fracture surgery under SAB were randomly divided. Group FICB received 25 ml of 0.25% bupivacaine and Group FNB got 15 ml. Pain was assessed using Numerical Rating Scale (NRS) scale. Time for first rescue dose, side effects, and patient satisfaction also noted. Results: Both groups had similar baseline NRS. Group FICB showed faster pain relief and better positioning comfort during SAB (NRS 3.00 vs. 4.28 P = 0.001). Time to first rescue analgesia was more in FICB (4.67 vs. 2.71 h P = 0.001). Satisfaction scores were also higher. Hemodynamics stayed stable, and adverse events were rare. Conclusion: USG-FICB is more effective than USG-FNB in controlling pain before SAB in femur fracture surgery.

Liver transplantation is the gold standard treatment for end-stage liver failure, and early extubation in the postoperative period is recommended to improve graft function. Coronary artery bypass grafting (CABG) is a surgical procedure to restore normal blood flow to an obstructed coronary artery. Patients undergoing cardiac surgery are often heparinized, which increases the risk of hematoma associated with regional anaesthesia, particularly central neuraxial techniques. Effective analgesic management plays a crucial role in achieving early extubation in both surgical procedures. Opioid agents are often preferred for analgesia management. However, the use of opioids in these patients increases the risk of complications; therefore, regional anaesthesia techniques are preferred. In the intensive care unit, we performed a combination of modified thoracoabdominal nerve block and pecto-intercostal fascial plane block as rescue analgesia in a patient who had undergone simultaneous liver transplantation and CABG.

The effect of scalp nerve block combined with inhaled peppermint essential oil on postoperative pain in patients undergoing supratentorial tumor resection.

Background:Effective post-operative pain management is essential for early recovery and patient satisfaction following knee arthroscopy. This study aimed to evaluate the post-operative analgesic efficacy and safety of ultrasound-guided adductor canal block (ACB) compared to conventional intravenous morphine analgesia.Materials and Methods:This randomized, controlled, interventional study was conducted in the post-anesthesia care unit (PACU) of the Department of Anesthesiology in an Indian Hospital. Eighty adult patients (American Society of Anesthesiologists [ASA] I–II) undergoing unilateral knee arthroscopy under general anesthesia were randomly divided into two groups: Group M received intravenous morphine (0.1 mg/kg) before incision, and Group B received an ultrasound-guided ACB with 15 mL of 0.25% bupivacaine before extubation. Post-operative analgesic efficacy was assessed by the requirement of rescue analgesia and the time to achieve a Visual Analog Score (VAS) <3. Adverse effects and antiemetic requirements were also recorded. Statistical analysis was performed using the Statistical Package for Social Sciences version 17.0, and a P < 0.05 was considered significant.Results:Both groups were comparable in terms of age, sex, ASA physical status, and pre-operative vitals (P > 0.05). Rescue analgesia in the PACU was required in 47.5% of patients in Group M and 10.0% in Group B (P < 0.001). The mean time to achieve VAS <3 was significantly shorter in Group B (11.00 ± 3.79 min) compared to Group M (16.00 ± 9.00 min) (P = 0.002). The requirement of antiemetic medication was lower in Group B (20.0%) than in Group M (42.5%) (P = 0.030). No adverse events were reported in either group.Conclusion:Ultrasound-guided ACB provides superior post-operative analgesia, faster pain relief, and fewer side effects compared to intravenous morphine in patients undergoing knee arthroscopy.

Background: Acupuncture has analgesic effects in animals. Common analgesics, such as opioids and anti-inflammatory drugs, are widely used to control postoperative pain in cats, but they can cause serious side effects. On the other hand, acupuncture can play a crucial role in replacing this kind of drug. Objectives: This study aims to evaluate the analgesic effects of acupuncture compared to tramadol and meloxicam on postoperative pain in cats after ovariohysterectomy. Methods: Forty-five adult stray cats were randomly distributed into three groups of fifteen animals each: TR: Tramadol (2 mg/kg IV) administered before anesthesia induction; ML: Meloxicam (0.2 mg/kg SC) administered after placement of the last skin suture; AC: Bilateral acupoints from kidney 11 (KI-11) to kidney 17 (KI-17) were stimulated. Postoperative pain was evaluated using the revised Glasgow composite pain scale-Feline and UNESP-Botucatu multidimensional composite pain scale (MCPS) up to 24 h after surgery. Rescue analgesia was provided intramuscularly with tramadol (2 mg/kg). Data were analyzed using the Kruskal-Wallis, Fisher’s exact probability test, and Friedman test. P&lt;0.05 is considered significant. Results: Mean pain scores did not significantly differ among groups at any time point (P&gt;0.05). The pain score and prevalence of rescue analgesia did not differ from the treatment groups over 24 h. Conclusion: Based on this study, analgesic effects of acupuncture were like tramadol and meloxicam during the first 24 h after Ovariohysterectomy in cats.

Effect of Esketamine for Patient-Controlled Intravenous Analgesia on Postoperative Sleep Disturbance in the Elderly After Total Hip or Knee Arthroplasty: A Prospective, Randomized, Double-Blind, and Controlled Trial.

Comparison of the Effect of Opioid Anesthesia and Opioid-free Anesthesia on Postoperative Recovery: A Systematic Review and Meta-analysis.

ABSTRACTBackground and AimsPostoperative anxiety (POA) is a frequently underrecognized complication in elderly surgical patients, with potential impacts on recovery and long‐term mental health. This study aimed to investigate the incidence of POA, identify associated risk factors, and evaluate its short‐term consequences in elderly individuals undergoing surgery.MethodsA retrospective observational study was conducted among patients aged 65 years and older who underwent elective surgery under general anesthesia between May 2020 and March 2021. Anxiety was measured using the Generalized Anxiety Disorder‐7 (GAD‐7) scale at baseline and during the first 7 days postoperatively. Postoperative pain, sleep quality, and other clinical outcomes were evaluated. Multivariable logistic regression identified independent risk factors for POA, and subgroup analyses were performed based on gender, frailty status, and surgery type. Missing data were handled using multiple imputation.ResultsAmong 308 eligible patients, 51.9% developed POA within 7 days post‐surgery. The highest incidence occurred after orthopedic (64.6%) and urologic (60%) procedures. POA was significantly associated with worse postoperative pain (higher NRS scores, increased use of rescue analgesia) and poorer sleep quality on postoperative days 1–3. Multivariable analysis revealed that preoperative anxiety (OR, 3.60; 95% CI, 1.76–7.40) and preoperative sleep disturbance (OR, 3.34; 95% CI, 1.82–6.13) were identified as independent risk factors of POA. Anxiety at 30 and 90 days after surgery was significantly increased compared with those without POA (26% vs 15% and 22% vs 12%, respectively).ConclusionPOA is prevalent in elderly surgical patients and is associated with worse early postoperative outcomes. Screening for anxiety and sleep disturbances before surgery may help identify high‐risk individuals. Early psychological or sleep‐focused interventions could improve recovery and prevent persistent anxiety symptoms.

Free and nanoencapsulated meloxicam as an adjuvant in intraoperative and postoperative analgesia in bicthes undergoing ovariohysterectomy.

Background: Post-operative pain following breast surgery can impair recovery and contribute to chronic pain syndromes. Ultrasound-guided pectoral nerve block (PECS I and II) blocks have emerged as effective regional anesthesia techniques. Adding adjuvants to ropivacaine may prolong analgesia and enhance patient comfort. Aims and Objectives: This study aims to compare the efficacy of 0.25% ropivacaine with dexmedetomidine versus 0.25% ropivacaine with magnesium sulfate in PECS I and II blocks for unilateral breast surgery. Materials and Methods: In this prospective, randomized, double-blind trial, 100 American Society of Anesthesiologists I–II female patients aged 18–60 years undergoing unilateral breast surgery under general anesthesia were allocated equally to receive PECS I and II blocks with ropivacaine plus dexmedetomidine (Group A) or ropivacaine plus magnesium sulfate (Group B). Primary outcomes included post-operative pain scores, Visual Analog Scale (VAS), time to first rescue analgesia, and total 24-h analgesic consumption. Secondary outcomes were intraoperative hemodynamics, patient satisfaction, and adverse effects. Results: Group A demonstrated significantly lower VAS scores at 1 h (1.61±0.51 vs. 1.92±0.57, P=0.02) and 6 h (2.33±0.68 vs. 3.09±0.72, P=0.001) postoperatively. Time to first rescue analgesia was longer in Group A (9.8±1.5 h vs. 6.5±2.0 h, P=0.002) with reduced paracetamol use over 24 h (1.905±0.450 g vs. 2.915±0.651 g, P=0.001). Patient satisfaction was higher in Group A (8.8±0.7 vs. 7.9±1.0, P=0.003). Hemodynamic parameters and adverse effects were comparable, though bradycardia was more frequent in Group A without clinical significance. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in PECS blocks provides superior early post-operative analgesia, prolonged pain-free intervals, reduced analgesic consumption, and higher satisfaction compared to magnesium sulfate, with similar safety.

Background Total hip arthroplasty (THA) in elderly patients is often associated with significant perioperative pain. This study aimed to evaluate the analgesic efficacy of fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENGB) in elderly patients undergoing THA. Methods This retrospective study included two patient groups: the PENGB group (n = 62) and the FICB group (n = 64). The primary outcome was the analgesic efficacy, assessed using Visual Analog Scale (VAS) pain scores at multiple postoperative time points. Secondary outcomes included motor blockade, the time to first rescue analgesia, postoperative analgesia quality and systemic inflammatory responses. Results PENGB provided significantly superior analgesia at 6 and 12 h postoperatively, as evidenced by lower VAS pain scores compared to the FICB group. Motor blockade was also less pronounced in the PENGB group at 3 and 6 h post-surgery. The time to first rescue analgesia was significantly longer in the PENGB group, indicating more sustained pain control. Additionally, PENGB was associated with reduced use of patient-controlled analgesia pumps and lower total sufentanil consumption. At 24 h postoperatively, interleukin-6 levels were significantly lower in the PENGB group, suggesting an attenuated inflammatory response. Conclusions Compared to FICB, PENGB provided superior analgesia in elderly patients undergoing THA.