Comparison between two different concentrations of ropivacaine in pericapsular nerve group block for patients undergoing total hip arthroplasty: A randomized clinical trial

Abstract

Effective pain control during spinal anesthesia positioning remains a clinical challenge in elderly patients undergoing total hip arthroplasty. The pericapsular nerve group block, a novel ultrasound-guided regional anesthesia technique, has shown promise for alleviating hip pain, yet the optimal concentration of local anesthetics for this approach remains unclear. In this randomized, observer-blinded clinical trial involving 102 patients, we compared the analgesic efficacy of two concentrations of ropivacaine (0.375% vs. 0.5%) administered via pericapsular nerve group block prior to spinal anesthesia. Patients receiving 0.5% ropivacaine reported significantly lower pain scores during positioning and demonstrated prolonged postoperative analgesia up to 48 hours, without a corresponding increase in adverse events. Both concentrations improved positioning quality, reduced opioid requirements, and enhanced recovery compared to controls who received standard intravenous analgesic supplementation (including preoperative midazolam and ketorolac, and postoperative sufentanil PCA), though the higher concentration yielded modest additional benefits. These findings suggest that a 0.5% ropivacaine pericapsular nerve group block may offer superior perioperative analgesia for hip arthroplasty without compromising safety, while highlighting the need to balance analgesic potency with potential motor effects. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. The trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400089440).