PENG block with bupivacaine reduces early POCD incidence after hip arthroplasty in older patientsPENG block may lower confusion and pain after hip surgery in older adults

PURPOSE: Postoperative cognitive dysfunction (POCD) is common in older patients undergoing orthopedic surgery and may hinder clinical recovery. This prospective study evaluated whether a preoperative pericapsular nerve group (PENG) block reduces POCD incidence in patients undergoing total hip arthroplasty (THA). METHODS: This prospective, randomized, double-blind study included older patients scheduled for elective THA under spinal anesthesia. Patients were randomized into 2 groups: PENG (group P) and control (group C). Group P underwent an ultrasound-guided PENG block containing 20 mL of 0.25% bupivacaine, while group C received a sham block. Cognitive performance was evaluated using the telephone version of the Mini-Mental State Examination (T-MMSE) preoperatively and on postoperative days 7, 30 and 90. We evaluated postoperative pain using the numerical rating scale (NRS) and recorded opioid consumption, time to mobilization, hospital stay duration, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). RESULTS: The final analysis included 84 patients (41 in group P and 43 in group C). There were no significant differences in demographic characteristics or intraoperative data between the groups (p > 0.05). The incidence of POCD on postoperative day 7 was lower in the PENG group (14.6% vs. 37.2%; p < 0.05). In the first 24h postoperatively group P reported significantly lower pain scores and opioid use (p < 0.001), were mobilized earlier and discharged sooner (p < 0.001). The NLR and PLR were lower in the PENG group at 24 and 48h postoperatively (p < 0.05). CONCLUSION: Preoperative PENG block may preserve early postoperative cognitive function in THA patients, through improved analgesia, reduced opioid consumption, attenuation of systemic inflammation, early mobilization and shorter hospital stay.