Vol 4 | Issue 1 | January-June 2023 | Page 13-19 | Chetana Bhalerao, Ujjwalraj Dudhedia
Authors: Chetana Bhalerao , Ujjwalraj Dudhedia 
 Department of Anaesthesia, Dr. L.H. Hiranandani Hospital Powai, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Chetana Vitthal Bhalerao,
Department of Anaesthesia, Dr. L.H. Hiranandani Hospital Powai, Mumbai, Maharashtra, India.
Background: Severe pain in hip fractures limits ideal positioning for spinal anaesthesia. We evaluated the analgesic efficacy of ultrasound-guided pericapsular nerve group block (PENG) and suprainguinal fascia iliaca block (SIFI) for positioning and postoperative pain relief in hip surgeries.
Methods: A prospective, randomized, double-blind study including 30 patients aged 30-90 years of either sex, American Society of Anesthesiologists’-physical status score I to II undergoing traumatic hip surgeries were divided into two groups. Each group was administered 20 ml bupivacaine 0.25% + 10 ml lignocaine 1%. Vitals and visual analogue scale (VAS) score pre-block, 10 mins post-block, after shifting to operation theatre and after positioning; at rest, and after straight leg raise (SLR) and quadriceps muscle strength were noted. The remaining aspects of perioperative care, including subarachnoid block and rescue analgesic techniques were standardized. Time to request first rescue analgesia, duration of block, and incidence of nausea was noted. Statistical analysis done using the Student t test, Chi-Square test.
Results: VAS scores in both groups 10 mins post block at rest, after SLR, and after positioning were comparable. The drop in VAS score although statistically insignificant was more in the PENG group. The motor blockade in SIFI was significantly higher compared to the PENG group (p-0.002). Duration of analgesia with SIFI 551.9 (±56.2) min was longer than PENG block 400.4 (±62.8) min (p=0.0005%). No significant difference between the groups to demographics, hemodynamic parameters, rescue analgesia and incidence of nausea.
Conclusion: PENG block provides superior and faster analgesia with potentially motor sparing effect compared to SIFI block whereas SIFI provides longer duration of analgesia.
Keywords: Analgesia, Pain, Regional Anaesthesia, Ultrasonography
 Shteynberg A, Riina LH, Glickman LT, Meringolo JN, Simpson RL. Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns. 2013;39: 146-9.
 Martins RS, M G Siqueira, Silva FC Jr, Heise CO, Teixeira MJ. A practical approach to the lateral cutaneous nerve of the thigh: an anatomical study. Clin Neurol Neurosurg. 2011; 113:868-71.
 Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg. 1997;100: 600-4.
 Benezis I, Boutaud B, Leclerc J, Fabre T, Durandeau A. Lateral femoral cutaneous neuropathy and its surgical treatment: a report of 167 cases. Muscle Nerve. 2007;36: 659-63.
 Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg. 2000;90: 119-24.
 Swenson JD, Davis JJ, Stream JO, Crim JR, Burks RT, Greis PE. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. J Clin Anesth. 2015;27: 652-7.
 Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120: 1368-1380.
 Ueshima H, Otake H. Supra-inguinal fascia iliaca block under ultrasound guidance for perioperative analgesia during bipolar hip arthroplasty in a patient with severe
cardiovascular compromise: A case report. Medicine. 2018; 97(40).
 Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018;43: 186-192.
 Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018;43: 859-63.
 White S, Stott P. Fascia iliaca block for primary hip arthroplasty. Anaesthesia. 2017;72 :409.
 K Shankar, Srinivasan Rangalakshmi, AB Ashwin, et al. Comparative Study of Ultrasound Guided PENG [Pericapsular Nerve Group] Block and FIB [Fascia Iliaca Block] for Positioning and Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries: Prospective Randomized Comparative Clinical Study. Indian J Anesth Analg.2020;7: 798-803.
 Jadon A, Mohsin K, Sahoo RK, Chakraborty S, Sinha N, Bakshi A. Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial. Indian J Anaesth. 2021;65: 572-578.
Bhattacharya A, Bhatti T, Haldar M. ESRA19-0539 Pericapsular nerve group block–is it better than the rest for pain relief in fracture neck of femur? Regional Anesthesia and Pain Medicine. 2019; 44(Suppl 1): A116.
 Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens Det al. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Regional Anesthesia & Pain Medicine. 2019;44: 483-91.
 Gasanova I, Alexander JC, Estrera K, Wells J, Sunna M, Minhajuddin A, Joshi GP. Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2019;44: 206-211.
 Ridderikhof ML, De Kruif E, Stevens MF, Baumann HM, Lirk PB, Goslings JC, Hollmann MW. Ultrasound guided supra-inguinal Fascia Iliaca Compartment Blocks in hip fracture patients: An alternative technique. Am J Emerg Med. 2020;38: 231-236.
 Bali C, Ozmete O. Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study. Braz J Anesthesiol. 2021: S0104-0014(21)00336-5.
 Yamada K, Inomata S, Saito S. Minimum effective volume of ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block. Sci Rep. 2020;10: 21859.
 Aydin ME, Borulu F, Ates I, Kara S, Ahiskalioglu A. A Novel Indication of Pericapsular Nerve Group (PENG) Block: Surgical Anesthesia for Vein Ligation and Stripping. J Cardiothorac Vasc Anesth. 2020;34: 843-845.
|How to Cite this Article: Bhalerao C, Dudhedia U | Prospective Comparative Double-Blind Study on Ultrasound- Guided Pericapsular Nerve Group Block Versus Suprainguinal Fascia Iliaca Block for Perioperative Analgesia in Traumatic Hip Surgeries | International Journal of Regional Anaesthesia | January-June 2023; 4(1): 13-19 | DOI:https://doi.org/10.13107/ijra.2023.v04i01.069