Assessment Of The Efficacy Of PENG Block As A Part Of Multimodal Analgesia, Compared To FICB, In Pediatric Hip Joint Surgery

BACKGROUND: Regional anesthesia plays a crucial role in the rapid recovery of patients. Peripheral regional blockades have emerged as a viable alternative to neuroaxial methods. However, the optimal technique for managing pain in hip joint surgery remains uncertain, particularly in pediatric patients. While the PENG block has demonstrated safety and effectiveness as an opioid-sparing technique in adults, its application in children is currently limited to case series. AIM: The study aimed to compare the perioperative analgesic efficacy of the PENG block and FICB in hip joint surgery for children. METHODS: A single-center prospective randomized trial was conducted involving 86 children who underwent reconstructive hip joint surgery. The participants were divided into two equal groups: the PENG group and the FICB group. All patients received combined endotracheal anesthesia with sevoflurane, while regional anesthesia was administered under ultrasound (US) guidance. Postoperatively, we assessed the total requirement for opioid analgesics, the time to the first request for emergency analgesia, and pain levels using the r-FLACC and NRS scales. Additionally, the analgesia-nociception index (ANI) was measured during the first 24 hours following regional anesthesia. Intraoperatively, we evaluated average blood pressure, heart rate, ANI, and the need for fentanyl administration. RESULTS: The total dosage of promedol did not differ significantly between the groups: in the PENG group, it was 0.12 (0-0.48) mg/kg, while in the FICB group, it was 0 (0-0.41) mg/kg. 24 patients (56%) in the PENG group and 17 patients (40%) in the FICB group required additional opioids. The time to the first requirement for opioids did not show a significant difference (p=0.1) between the groups, with a median of 11 (12.0-24.0) hours for the PENG group and 24 (5.0-24.0) hours for the FICB group. Pain levels in children, assessed using both pain scales, did not differ significantly. Analysis of the ANI indicators revealed a statistically significant difference (p=0.02) between the groups at the 24-hour observation point. The median ANI in the PENG group after 24 hours was lower than that in the FICB group, at 69 and 81, respectively. Additionally, there was an increase in blood pressure and heart rate during the skin incision phase in the PENG group, while no such changes were observed in the FICB group. No adverse events or complications occurred during the implementation of either method. CONCLUSION: The PENG block can be used during hip joint surgery in pediatric patients as a safe and effective part of multimodal analgesia. The demand for opioids, the time until emergency analgesia, and the intraoperative requirement for opioid analgesics are similar to those associated with the FICB.