Discussion
femoral neck fractures, femoral nerve block, nausea and vomiting, postoperative exercise pain, pain, PENG block, THA
ADVERSE REACTIONS
In this study, a total of 57 patients with femoral neck fractures were randomly assigned to receive either continuous pericapsular nerve group (PENG) block (PENG group, n = 29) or continuous fascia iliaca compartment block (FICB group, n = 28). The results showed that both groups improved exercise NRS pain scores during the observation period compared to preoperative scores. However, the passive straight leg raises 15° VAS scores were consistently lower in the PENG group than in the FICB group during the same time frame. The possible reasons for this discrepancy can be analyzed as follows. Swenson et al. discovered through magnetic resonance imaging that using 30 ml of 0.25% bupivacaine for FICB did not reach the pectineus muscle effectively, failing to achieve complete obturator nerve blockade [A previous investigation has demonstrated the beneficial impact of early mobilization on postoperative recovery and length of hospital stay [The findings of this investigation indicate that, in the PENG group, postoperative quadriceps strength on the affected side was slightly lower than that of the healthy side (without statistical significance). In contrast, the FICB group exhibited significantly lower quadriceps strength on the affected side than the healthy one. Furthermore, during the same period, the postoperative quadriceps strength on the affected side was significantly higher in the PENG group than in the FICB group. These outcomes are consistent with a previous study by Hao et al., which demonstrated improved quadriceps strength with PENG block in patients undergoing THA [The findings of this investigation revealed that the PENG group exhibited a significantly lower number of effective PCNA compressions in the postoperative 0–24 h and 24–48 h periods, as well as a lower number of rescue analgesia administrations compared to the FICB group (P < 0.05). This observation may be attributed to the challenges faced by the FICB group in achieving a complete obturator block nerve or even femoral nerve block, given the constant 5 ml/h continuous infusion dose of PCNA for the iliac fascia gap area and the diminishing effect of spinal anesthesia. Consequently, more PCNA compressions and rescue analgesia were required in the FICB group to alleviate postoperative exercise pain. These findings suggest that a higher continuous infusion dose of PCNA may be necessary to effectively manage exercise pain 24 h after THA in continuous FICB. Notably, three individuals in the FICB group experienced nausea and vomiting after receiving ketorolac tromethamine for rescue analgesia. However, no significant difference between the two groups was observed in the occurrence of nausea and vomiting. Further investigations with an expanded sample size are warranted to validate these findings. Importantly, no adverse reactions such as puncture site hematoma or catheter displacement were observed in either group after surgery, which aligns with previous research [