SFIB vs PENG Block in the Anesthesia for Total Hip Replacement

Patients will be randomized into three groups group:

Group 1: General anesthesia with SFIB

In this group, under the ultrasound control, a local anesthetic will be injected into the interfacial space of the iliac muscle, in the area of the passage of the deep artery that surrounds the ilium. The block will be performed over the inguinal fold medial to the upper anterior iliac spine. After ultrasound identification of the needle's location in the interfacial space, 40 ml of a 0.5% solution of Ropivacaine will be administered.

Group 2: General anesthesia with PENG block

The block is performed using ultrasound navigation. After identifying the ileo-lumbar tendon, 40 ml of 0.5% Ropivacaine solution is injected under it. Ropivacaine spreads through the hip joint capsule and blocks small sensitive branches of the femoral and obturator nerves.

Group 3: Control group with general inhalation anesthesia

The control group will undergo general inhalation anesthesia with bolus intraoperative administration of Fentanyl before particularly traumatic stages. For postoperative pain relief, the patient will have the opportunity to use a fentanyl bolus according to the patient-controled analgesia protocol.

The following parameters will be evaluated

• Hemodynamic parameters in the intraoperative period
• Intraoperative monitoring of basal metabolic rate using indirect calorimetry
• Monitoring of glucose levels during the most traumatic stages of surgery
• Recording the total dose of opioid analgesics in the perioperative period
• Degree of postoperative pain and analgesic therapy administered
• Block execution time
• Complications of conducting anesthesia
• Degree of patient satisfaction with anesthesia

Inclusion criteria

• Signed, dated informed consent form
• Age from 50 to 75 years
• Indications for primary total hip replacement
• American Society of Anesthesiologists (ASA) score from 1 to 3

Exclusion criteria

• Patients receiving beta blockers;
• Infectious manifestations at the puncture site;
• Bleeding, clinically significant hypovolemia of any origin, shock;
• Disorders of the blood coagulation system;
• Intolerance to local anesthetics;
• Demyelinating diseases of the nervous system;
• Allergy to local anesthetics;
• Psychiatric diseases;
• Any conditions that prevent obtaining informed consent.