postoperative analgesia for hip surgery

Blocks for Hip AnalgesiaFascia Iliaca Block :Block of the nerves of the lumbar plexus under the fascia iliaca at the level of the inguinalligament (femoral and lateral femoral cutaneous nerves). The fascia iliaca block has evolved from theinfrainguinal "classic" approach to a suprainguinal technique with the aim to spread the LA injection cranially,more consistently reaching the lumbar plexus, and resulting in analgesic efficacy superior to the infrainguinalapproac.Indications: Analgesia for hip and femur fractures, analgesia after hip and knee surgery, and procedures onthe anterior thighGoal: Medial, lateral, and cranial spread of local anesthetic (LA) under the fascia iliacaLocal anesthetic volume: ۲۰ to ۴۰ mLPericapsular nerve group block:The hip (PENG) block consists of an infiltration of local anesthetic (LA) alongthe proximal insertion of the anterior hip capsule, deep to the iliopsoas muscle, to block the sensory branchessupplying the hip joint. In addition to the infiltration, a lateral femoral cutaneous nerve (LFCN) block can beperformed for hip surgery.Fascia iliaca and femoral nerve block result in motor weakness of the quadriceps muscle, limiting their utility inenhanced recovery protocols and potentially increasing the risk of falls. As a result of the search for alternativeinterventional analgesia modalities to provide a selective articular sensory block, several pericapsular infiltrationtechniques have been proposed.Indications: Analgesia after total hip arthroplasty or other hip surgeries resulting in moderate to severepostoperative pain and chronic hip painGoal: LA spread in the plane between the iliopsoas muscle and anterior capsule of the hip cranially to theacetabular rimLocal anesthetic volume: ۱۰ to ۱۲ mL