PENG block with bupivacaine reduces early POCD incidence after hip arthroplasty in older patients

This prospective, randomized, double-blind study evaluated 84 older patients scheduled for elective total hip arthroplasty under spinal anesthesia. Patients were randomized to receive either an ultrasound-guided pericapsular nerve group (PENG) block containing 20 mL of 0.25% bupivacaine (n=41) or a sham block (n=43). The primary outcome was the incidence of postoperative cognitive dysfunction (POCD), assessed at postoperative days 7, 30, and 90.

The incidence of POCD on postoperative day 7 was significantly lower in the PENG group (14.6%) compared to the control group (37.2%), a statistically significant reduction (p < 0.05). Secondary outcomes also favored the intervention: pain scores and opioid consumption in the first 24 hours were significantly lower (p < 0.001), time to mobilization was earlier (p < 0.001), and hospital stay duration was shorter (p < 0.001). Inflammatory markers (neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios) at 24 and 48 hours were also lower in the PENG group (p < 0.05).

Safety and tolerability data, including adverse events and discontinuations, were not reported in the provided evidence. Key limitations of the study, such as sample size, generalizability, or specific methodological constraints, were also not detailed. The lack of reported safety data and unspecified limitations necessitate a cautious interpretation.

For clinical practice, this study provides preliminary evidence that a PENG block with dilute bupivacaine may be associated with a lower rate of early POCD and improved early recovery metrics in a specific surgical population. The findings are relevant for anesthesiologists and surgeons managing older adults undergoing hip arthroplasty. However, the absence of safety reporting and the need for replication in larger, more diverse cohorts mean this should be considered an encouraging signal rather than definitive practice-changing evidence.