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Purpose <p>Postoperative cognitive dysfunction (POCD) is common in older patients undergoing orthopedic surgery and may hinder clinical recovery. This prospective study evaluated whether a&#xa0;preoperative pericapsular nerve group (PENG) block reduces POCD incidence in patients undergoing total hip arthroplasty (THA).</p> Methods <p>This prospective, randomized, double-blind study included older patients scheduled for elective THA under spinal anesthesia. Patients were randomized into 2&#xa0;groups: PENG (group&#xa0;P) and control (group&#xa0;C). Group&#xa0;P underwent an ultrasound-guided PENG block containing 20 mL of 0.25% bupivacaine, while group&#xa0;C received a&#xa0;sham block. Cognitive performance was evaluated using the telephone version of the Mini-Mental State Examination (T-MMSE) preoperatively and on postoperative days&#xa0;7, 30 and&#xa0;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).</p> Results <p>The final analysis included 84&#xa0;patients (41&#xa0;in group&#xa0;P and&#xa0;43 in group&#xa0;C). There were no significant differences in demographic characteristics or intraoperative data between the groups (<i>p</i> &gt; 0.05). The incidence of POCD on postoperative day&#xa0;7 was lower in the PENG group (14.6% vs. 37.2%; <i>p</i> &lt; 0.05). In the first 24h postoperatively group&#xa0;P reported significantly lower pain scores and opioid use (<i>p</i> &lt; 0.001), were mobilized earlier and discharged sooner (<i>p</i> &lt; 0.001). The NLR and PLR were lower in the PENG group at 24&#xa0;and 48h postoperatively (<i>p</i> &lt; 0.05).</p> Conclusion <p>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.</p>

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Effect of pericapsular nerve group block on postoperative cognitive function in older patients undergoing total hip arthroplasty

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Gokhan Erdem,
  • Burak Nalbant,
  • Fatma Kavak Akelma,
  • Enes Sağlam,
  • Dilara Erdem,
  • Ayşe Lafçı

摘要

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.