High-versus conventional-volume pericapsular nerve group (PENG) block for total hip arthroplasty: A randomized, controlled trial

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: No significant difference: median 5(4,6) vs 4(4,5) on pain scale

• Primary Outcome: Dynamic pain scores at 6 hours post-surgery

• Nnt Or Sensitivity: Not applicable - no significant benefit demonstrated

• Confidence Interval: Not reported

Clinical Application

PENG blocks are feasible in Australian practice with ultrasound guidance, though require trained anaesthetists. Conventional volume appears adequate Relevant to Australian orthopaedic and anaesthetic practice. Ropivacaine is PBS-listed. ANZCA guidelines support regional anaesthesia for hip surgery. Results suggest conventional volume PENG blocks are sufficient Adults undergoing primary total hip arthroplasty under spinal anaesthesia in Australian public and private hospitals

Abstract

BACKGROUND: Currently, the optimal volume of pericapsular nerve group (PENG) block for analgesia after total hip arthroplasty (THA) has not been clarified. In this trial, we investigated whether a high-volume PENG block has a superior analgesic effect than a conventional PENG block for primary THA. METHODS: Forty patients receiving primary THA under spinal anesthesia were enrolled and randomly divided into the high-volume PENG group (40 mL of 0.375% ropivacaine) and the conventional-volume PENG group (20 mL of 0.375% ropivacaine). Dexamethasone (5 mg) was added to the local anesthetic in both groups. A blinded researcher performed pain scores and lower limb sensory and motor block assessments at 3, 6, and 24 h after surgery. The time of first walking, time of first opioid consumption, total opioid consumption within 48 h, nerve block, opioid-related complications, and length of hospital stay were recorded. The primary outcome was the dynamic pain scores at 6 h post-surgery. RESULTS: Thirty-seven patients were included in the final analysis, among whom 18 were in the high-volume group and 19 in the conventional-volume group. There were no significant differences between the two groups in dynamic pain scores at 6h after surgery [median and interquartile range (p25, p75) 5(4,6) vs 4 (4,5)] and other secondary outcomes. CONCLUSIONS: The high-volume PENG block is not superior to conventional-volume PENG block in improving post-operative analgesia in patients undergoing primary THA and does not increase the risk of quadriceps weakness. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn). Clinical trial registration number: ChiCTR2300077281.

References

1. 1.Wang, Q. S., Qin, S. M., Zhao, Y., Gao, C. M., Yuan, X., & Chen, Z. H. (2026). High-versus conventional-volume pericapsular nerve group (PENG) block for total hip arthroplasty: A randomized, controlled trial. PLoS One. https://doi.org/10.1371/journal.pone.0343615