Ultrasound-guided pericapsular nerve group block versus caudal epidural block for postoperative pain management in pediatric hip surgery: A randomized clinical trial

Abstract

Introduction

Optimal pain control after pediatric hip surgery enhances recovery, minimizes opioid needs, and improves comfort. The pericapsular nerve group (PENG) block, a unique regional intervention, has advantages over the standard caudal epidural block (CEB). This study compares the analgesic efficacy of ultrasound-guided PENG and CEB blocks in children having hip surgery.

Methods

This study included 80 pediatric patients, aged 1 to 7 years, who received general anesthesia for hip surgery. Patients were randomly allocated to receive either a PENG block (Group P) using 0.5 mL/kg of 0.25% bupivacaine, or a CEB (Group C) using equivalent bupivacaine volume. The primary outcome was postoperative pain assessed by the FLACC scale at predefined timepoints. Secondary measured outcomes were the time until the first rescue analgesic, total morphine usage, occurrence of adverse effects, and parental satisfaction.

Results

Pain scores were generally comparable, but Group C showed significantly lower FLACC scores at 30 min (p = .047), while Group P had lower scores at 6 h (p = .024). Group P demonstrated a significantly longer time to first rescue analgesic (10.68 ± 7.03 vs 7.85 ± 4.77 h, p = .039) and lower morphine consumption (p = .047). Block performance time was greater in Group P (p < .001), but higher parental satisfaction was noted (p = .03). The safety profile was equivalent between groups, with no significant disparity in adverse effect frequency.

Conclusion

For pediatric hip surgery, ultrasound-guided PENG block provides long-lasting postoperative analgesia compared to CEB, while reducing opioid needs and enhancing parent satisfaction.