Bloqueios nervosos periféricos guiados por ultrassom na osteoartrite do quadril

INTRODUCTION: Hip osteoarthritis (OA) represents one of the main causes of chronic pain and functional disability, affecting approximately 25% of the population over a lifetime. With population aging and the increasing prevalence of obesity, the demand for effective and less invasive therapeutic alternatives has grown significantly. Ultrasound-guided peripheral nerve blocks have emerged as promising strategies, providing targeted analgesia with minimal systemic effects, especially in patients with surgical contraindications or those refractory to conservative treatment. OBJECTIVES: To provide a comprehensive review of the pericapsular nerve group (PENG) block and posterior hip capsule block techniques in the treatment of hip osteoarthritis, analyzing the relevant anatomy, technical considerations, clinical evidence of efficacy and safety, as well as establishing guidelines for their practical application in contemporary clinical practice. MATERIAL AND METHODS: A narrative literature review was conducted using the PubMed, Scopus, and Cochrane Library databases, including randomized clinical trials, meta-analyses, observational studies, and case reports published between 2018 and 2024. The inclusion criteria comprised studies that evaluated the efficacy and safety of PENG block and posterior capsule block in patients with hip osteoarthritis, hip fractures, and total hip arthroplasty. Anatomical and technical aspects, clinical outcomes, and complications associated with these techniques were analyzed. RESULTS: The PENG block demonstrated superior efficacy across multiple clinical contexts, including perioperative analgesia in total hip arthroplasty, treatment of hip fractures, and conservative management of osteoarthritis. Randomized clinical trials have shown a significant reduction in opioid consumption (30–50%), improved pain scores within the first 24–48 postoperative hours, and preservation of quadriceps function. The block outperformed conventional techniques such as the fascia iliaca block in terms of analgesic efficacy. The posterior capsule block, although supported by more limited evidence, has shown promise as an adjuvant technique, particularly in patients with predominantly posterior pain. The combination of both techniques provided more comprehensive analgesic coverage of the complex hip innervation, with a favorable safety profile and absence of significant motor complications. CONCLUSION: Ultrasound-guided peripheral nerve blocks, particularly the PENG block, represent significant advances in the therapeutic arsenal for hip osteoarthritis. The PENG block has established itself as a first-line technique for anterior hip pain, with robust evidence supporting its efficacy and safety. The posterior capsule block provides valuable complementary coverage for posterior pain. Both techniques offer effective analgesia with functional preservation, reduced opioid consumption, and improved quality of life. Future research should focus on large-scale randomized trials, standardized protocols, and the evaluation of longterm outcomes to definitively establish the role of these techniques in the multimodal management of hip osteoarthritis.