High-volume PENG block with dexamethasone showed no analgesic advantage over conventional volume in primary total hip arthroplasty.

This randomized, controlled trial evaluated 40 patients receiving primary total hip arthroplasty under spinal anesthesia, with 37 included in the final analysis. Participants were stratified into a high-volume group (18 patients) and a conventional-volume group (19 patients). The intervention involved a PENG block with 40 mL of 0.375% ropivacaine plus 5 mg dexamethasone for the high-volume group, compared to 20 mL of 0.375% ropivacaine with 5 mg dexamethasone for the conventional-volume group.

The primary outcome measured dynamic pain scores at 6 hours post-surgery. Results showed no significant difference between groups, with the high-volume group reporting a median pain score of 5 (IQR 4-6) versus a median of 4 (IQR 4-5) in the conventional-volume group. Secondary outcomes included lower limb sensory and motor block assessments at 3, 6, and 24 hours, as well as time to first walking and opioid consumption.

Safety data indicated that the high-volume PENG block did not increase the risk of quadriceps weakness. No adverse events, serious adverse events, or discontinuations were reported. Opioid-related complications and length of hospital stay were recorded as secondary outcomes, though specific comparative statistics for these were not detailed in the provided results. The study followed patients for 3, 6, and 24 hours for block assessments, with opioid consumption tracked up to 48 hours.

Limitations include the small sample size and the lack of reported p-values or confidence intervals for the primary outcome. Funding and conflicts of interest were not reported. The practice relevance concludes that high-volume PENG block is not superior to conventional-volume PENG block for improving post-operative analgesia in patients undergoing primary total hip arthroplasty.