PENG Block Optimization: Volume and Dexamethasone Effects

Summary

This randomized controlled trial investigates the impact of local anesthetic volume and perineural dexamethasone on the analgesic and anti-inflammatory effectiveness of the pericapsular nerve group (PENG) block in patients undergoing total hip arthroplasty (THA). Patients were randomized to receive one of four PENG block variants differing in ropivacaine volume (10 mL or 20 mL of 0.2%) and the addition of 4 mg of perineural dexamethasone. The study evaluates postoperative pain, opioid requirements, systemic inflammatory markers, and quadriceps motor preservation.

Eligibility

Inclusion Criteria:

* Adults aged ≥18 years scheduled for primary unilateral total hip arthroplasty (THA).
* American Society of Anesthesiologists (ASA) physical status I-III.
* Ability to provide written informed consent.
* Spinal anesthesia planned as the primary anesthetic technique.
* Body mass index (BMI) between 18 and 35 kg/m².
* Fluent in the local language and able to understand the NRS pain scoring system.

Exclusion Criteria:

* Known allergy or hypersensitivity to ropivacaine, dexamethasone, or other amide local anesthetics.
* Pre-existing neurological deficits or neuropathies affecting lower limb motor or sensory function.
* Chronic opioid use (daily use \>30 mg oral morphine equivalents for \>1 month prior to surgery).
* History of coagulopathy, current anticoagulant therapy not eligible for regional anesthesia.
* Uncontrolled diabetes mellitus (HbA1c \> 9%) or active systemic infection.
* Pregnancy or breastfeeding.
* Previous surgery or implantation on the ipsilateral hip.
* Inability to cooperate with postoperative assessments or participate in follow-up.

Conditions4

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