Pediatric hip surgeries are associated with moderate to high levels of pain, which, in severe cases can lead to opioid prescription and use. There is a growing focus on reducing post-operative pain in these patients to decrease the need for opioids, as well as increase early mobilization for recovery. Conventional methods of pain relief using opioids can have unwanted negative impacts on pediatric patients such as respiratory depression, nausea, confusion, and the concerning possibility for the development of dependence. Likewise, traditional methods of anesthesia, like the lumbar epidural block, can have unwanted systemic side effects, such as hypotension, urinary retention, arrhythmias, and spinal abscesses. These complications can lead to longer hospital stays and delayed recovery. This review analyzes the efficacy of a newer regional anesthesia technique, the pericapsular nerve group (PENG) block, in comparison to the lumbar epidural block. This technique utilizes precision-based anesthesia to selectively block the articular branches to the hip joint while avoiding the main trunks of the femoral and obturator nerves. Additionally, with the utilization of high-resolution ultrasound to guide the blocks, providers can increasingly count on proper insertion and predictable anesthetic spread. The result is a motor-sparing blockade that shows promise in allowing earlier mobilization and better functional recovery times after pediatric hip surgeries.

Background: The opioid epidemic has highlighted the need for alternative pain management modalities in postoperative patients. Peripheral nerve blocks (PNBs) have been shown to reduce opioid consumption in the immediate postoperative period, but limited data exists on their impact on chronic opioid use. Objective: The present investigation focused on the use of preoperative PNB utilization in orthopedic surgeries and its association with chronic opioid use. Methods: A retrospective cohort study was conducted on 533 patients that had a total shoulder arthroplasty, reverse total shoulder arthroplasty, or knee arthroscopy between July 2021 and July 2024. Patients were grouped based on whether they received a preoperative PNB. Opioid prescription data were collected at 1-, 3-, and 6-month postoperative periods. In addition, a subset of patients completed a questionnaire to assess self-reported opioid consumption and other analgesic usage. Results: Patients who received a PNB were significantly less likely to report continued opioid use at one month postoperatively compared to those who did not (32.8% vs. 61.9%). Additionally, PNB recipients more often declined additional opioids due to a lack of need (p = 0.025), while those without a PNB cited other reasons, including fear of addiction or poor pain control (p = 0.033). Conclusions: The results of the present investigation suggest that preoperative PNBs may be associated with reduced chronic opioid use and have an important role in prescribing practices and pain management strategies following orthopedic surgery. Limitations: The limitations are as follows: retrospective design; potential recall and selection bias from questionnaire use; lack of data confirming actual opioid prescription fills; inclusion of patients with chronic pain comorbidities requiring long-term opioid use.