Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block (ESPB) in Pediatric Hip Surgery: A Randomized, Double-Blinded, Controlled Trial

Abstract

Background: The effectiveness and safety of the pericapsular nerve group (PENG) block and lumbar erector spinae plane block (ESPB) in pediatric hip surgeries is limited mainly to case reports. This study assessed the efficacy of ultrasound-guided PENG block versus lumbar ESPB under spinal anesthesia. Methods: Ninety patients aged 2 to 7 years, ASA I-III scheduled for hip surgery were randomly assigned to 3 equal groups, each receiving the PENG block group (n=30), the ESPB group (n=30), or the control group (n=30). After the spinal anesthesia, the block was performed with 0.5 kg/mL of 0.2% ropivacaine. The primary outcome was the pain scores (FLACC) 48 hours after surgery. The secondary outcomes included postoperative FLACC pain scores, neutrophile-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total opioid consumption. Results: The FLACC score was significantly lower in the lumbar ESPB and PENG groups compared with the control group (P<0.0001) at all time points. The NLR and PLR levels were substantially lower in the PENG and lumbar ESPB groups (P<0.0001) compared with the control group. The NLR and PLR levels were significantly lower in the PENG and lumbar ESPB groups compared with the control group (P<0.0001). The total opioid consumption was significantly lower in the PENG and lumbar ESPB groups compared with the control group (P<0.0001). Forty-three percent of children in the PENG group and 50% of children in the lumbar ESPB group did not require opioids postoperatively. Conclusions: The PENG block and the lumbar ESPB provide efficient postoperative analgesia in children undergoing hip surgery. The PENG block and lumbar ESPB lower cumulative opioid consumption and the stress response to surgery, expressed by NLR and PLR levels. Level of evidence: Level I.