Zainab Mohamed Abd Elwahab Mahmoud
Lecturer
Ultrasound-guided pericapsular nerve group block versus caudal epidural block for postoperative pain management in pediatric hip surgery: A randomized clinical trial
• 2026
Publication Information
Authors
Samar Rafik Amin1, Mona Ahmed Elhadad1, Eslam Abdelshafy Tabl2 and
Zeinab Mohammed Abdelwahab1
Keywords
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publication.type
Local
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Supplementary Materials
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Abstract
Abstract
Introduction: Optimal pain control after pediatric hip surgery enhances recovery, minimizes opioid needs, and
improves comfort. The pericapsular nerve group (PENG) block, a unique regional intervention, has advantages
over the standard caudal epidural block (CEB). This study compares the analgesic efficacy of ultrasound-guided
PENG and CEB blocks in children having hip surgery.
Methods: This study included 80 pediatric patients, aged 1 to 7 years, who received general anesthesia for hip
surgery. Patients were randomly allocated to receive either a PENG block (Group P) using 0.5 mL/kg of 0.25%
bupivacaine, or a CEB (Group C) using equivalent bupivacaine volume. The primary outcome was postoperative
pain assessed by the FLACC scale at predefined timepoints. Secondary measured outcomes were the time until
the first rescue analgesic, total morphine usage, occurrence of adverse effects, and parental satisfaction.
Results: Pain scores were generally comparable, but Group C showed significantly lower FLACC scores at
30 min (p = .047), while Group P had lower scores at 6 h (p = .024). Group P demonstrated a significantly longer
time to first rescue analgesic (10.68 ± 7.03 vs 7.85 ± 4.77 h, p = .039) and lower morphine consumption (p = .047).
Block performance time was greater in Group P (p < .001), but higher parental satisfaction was noted (p = .03).
The safety profile was equivalent between groups, with no significant disparity in adverse effect frequency.
Conclusion: For pediatric hip surgery, ultrasound-guided PENG block provides long-lasting postoperative
analgesia compared to CEB, while reducing opioid needs and enhancing parent satisfaction.
Introduction: Optimal pain control after pediatric hip surgery enhances recovery, minimizes opioid needs, and
improves comfort. The pericapsular nerve group (PENG) block, a unique regional intervention, has advantages
over the standard caudal epidural block (CEB). This study compares the analgesic efficacy of ultrasound-guided
PENG and CEB blocks in children having hip surgery.
Methods: This study included 80 pediatric patients, aged 1 to 7 years, who received general anesthesia for hip
surgery. Patients were randomly allocated to receive either a PENG block (Group P) using 0.5 mL/kg of 0.25%
bupivacaine, or a CEB (Group C) using equivalent bupivacaine volume. The primary outcome was postoperative
pain assessed by the FLACC scale at predefined timepoints. Secondary measured outcomes were the time until
the first rescue analgesic, total morphine usage, occurrence of adverse effects, and parental satisfaction.
Results: Pain scores were generally comparable, but Group C showed significantly lower FLACC scores at
30 min (p = .047), while Group P had lower scores at 6 h (p = .024). Group P demonstrated a significantly longer
time to first rescue analgesic (10.68 ± 7.03 vs 7.85 ± 4.77 h, p = .039) and lower morphine consumption (p = .047).
Block performance time was greater in Group P (p < .001), but higher parental satisfaction was noted (p = .03).
The safety profile was equivalent between groups, with no significant disparity in adverse effect frequency.
Conclusion: For pediatric hip surgery, ultrasound-guided PENG block provides long-lasting postoperative
analgesia compared to CEB, while reducing opioid needs and enhancing parent satisfaction.