Pericapsular Nerve Group Block Significantly Reduces Morphine Consumption and Improves Early Recovery Following Primary Total Hip Arthroplasty: A Randomized Double-Blind Sham-Controlled Trial
In brief
Pericapsular nerve group block cuts 24-hour morphine use by 79% after hip replacement
In a randomized trial of 40 patients, the nerve block group used an average of 6.2 mg of morphine in the first 24 hours, compared with 30.2 mg after a sham procedure. Patients also reported less pain and nausea, but the small, single trial leaves the size and reliability of benefit in broader practice uncertain.
- Journal
- The Journal of arthroplasty (Q1)
- Published
- 6 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Fatma Demirkıran, İclal Özdemir Kol, Ozan Altun
- PMID
- 42994648
- DOI
- 10.1016/j.arth.2026.11.004
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 7 November 2026): Randomized trial of PENG block opioid-sparing analgesia
Abstract
BACKGROUND: The pericapsular nerve group (PENG) block has emerged as a promising regional analgesic technique for hip surgery. However, evidence regarding its opioid-sparing efficacy following primary total hip arthroplasty remains limited. This study evaluated the effect of ultrasound-guided PENG block on postoperative opioid consumption, pain scores, and recovery outcomes following primary total hip arthroplasty. METHODS: In this prospective, randomized, double-blind, sham-controlled trial, 40 patients undergoing elective primary total hip arthroplasty under general anesthesia were randomized to receive either ultrasound-guided PENG block with one mg/kg bupivacaine diluted to 30 mL (n = 20) or a sham procedure with 30 mL saline (n = 20). The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. The secondary outcomes included visual analog scale (VAS) pain scores, time to first rescue analgesia, patient satisfaction, and opioid-related adverse events. Baseline characteristics were comparable between groups. RESULTS: Cumulative morphine consumption was significantly lower in the PENG group throughout the postoperative period and at 24 hours (6.2 ± 3.3 versus 30.2 ± 5.6 mg, P < 0.001), representing an approximately 79% reduction in opioid requirement. The visual analog scale pain scores were significantly lower at all postoperative assessment points (all P < 0.001). Time to first rescue analgesic requirement was significantly prolonged in the PENG group (16.0 ± 0.0 versus 1.4 ± 0.5 hours, P < 0.001). Patient satisfaction was significantly greater in the PENG group (P < 0.001), while postoperative nausea occurred less frequently (zero versus 25%, P = 0.017). There were no block-related complications observed. CONCLUSIONS: Ultrasound-guided PENG block provided effective opioid-sparing analgesia following primary total hip arthroplasty, significantly reducing postoperative morphine consumption and pain scores while improving patient satisfaction and reducing postoperative nausea. These findings support the incorporation of PENG block into multimodal analgesic protocols for total hip arthroplasty.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.