الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
Total hip arthroplasty (THA) is one of the most common major orthopedic procedures to improve patient’s functional status and quality of life. However, despite these advantages, the immediate postoperative period can be associated with severe pain that delays mobilization and increases hospital stay and risk of thromboembolic events. Spinal anesthesia is a regional anesthetic technique that commonly used in patients undergoing THA. Opioids are added to the spinal anesthetic to prolong and improve postoperative pain relief. Also, are associated with decrease postoperative analgesic requirement. However, intrathecal opioids are associated with side-effects as urinary retention, nausea, vomiting, pruritis and rarely, respiratory depression. Such adverse effects may be uncomfortable for the patients and delay recovery and discharge. Ultrasound guided peripheral nerve blocks have been shown to be associated with fewer side effects and greater efficacy when used in multimodal approach. Lumbar PVB is an effective approach for postoperative pain relief, Injection of local anesthetic at the level of L1 and L2 will cover the surgical area of the hip surgery. The caudal spread of the local anesthetic provides analgesia to the femoral and obturator nerve distribution providing good analgesia and early ambulation. PENG block is anew and promising ultrasound-guided regional anesthesia technique, aiming to block the branches of femoral nerve, obturator nerve and accessory obturator nerve innervating the anterior hip capsule with preservation of motor function resulting in enhancing ambulation and early discharge. The aim of the work is to compare the analgesic efficacy of lumbar PVB versus PENG in patients undergoing THA. This study included seventy-four patients, aged ≥ 21 years, of both genders scheduled for unilateral hip arthroplasty, they were randomly allocated into two groups. group I received Spinal anesthesia combined with Ultrasound guided LPVB, A bolus dose of bupivacaine 0.25% in a volume of 20 mL was injected. group II received Spinal anesthesia combined with Ultrasound guided PENG, A bolus dose of bupivacaine 0.25% in a volume of 20 mL was injected. In both groups, VAS decreased significantly after institution of blocks with significant increase in group II compared to group I at 4hrs & 12hrs.while there was no significant difference between groups regarding the first rescue analgesia and the amount of total opioid consumption. Also, HR & MAP decreased after institution of blocks with significant increase in group II compared to group I at recovery, 2hrs &4hrs. Moreover, there was significant increase in group II compared to group I concerning the duration of sensory block, while there was no significant difference between both groups in duration of motor block. Comparing complications and side effects between both groups, there was one patient who developed hematoma in the PVB group versus none in the PENG group resulting in insignificant difference between both groups.