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Background and Aims Adequate postoperative analgesia is critical for elderly patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block relieves pain while preserving motor function, but its limited duration necessitates adjuncts. This study evaluates the efficacy of perineural dexamethasone in prolonging PENG block analgesia in geriatric THA patients.Methods This double-blinded, randomized controlled trial (RCT) was conducted at a single orthopedic center in Poland. The Bioethics Committee of Poznan University of Medical Sciences approved the study (protocol 107/2024). Written informed consent was obtained from all patients before enrollment (August 14, 2024 – January 31, 2025). The study adhered to the Declaration of Helsinki. Sixty patients (≥65 years) undergoing total hip arthroplasty (THA) under spinal anesthesia were randomized into two groups: PENG group (PENG block with 20 mL 0.2% ropivacaine) and PENG+DEX group (PENG block with 20 mL 0.2% ropivacaine + 4 mg perineural dexamethasone). The primary outcome was the time to first rescue opioid administration. Secondary outcomes included total opioid consumption (mEQ), pain scores (NRS), quadriceps strength (MRC scale), and adverse effects (hyperglycemia, nerve injury) over 48 hours.Results Dexamethasone significantly prolonged analgesia (16.0 ± 1.3 vs. 9.0 ± 1.7 hours, p < 0.0001) and reduced opioid use (0.9 ± 1.2 vs. 2.1 ± 1.4 mEQ, p = 0.0003). Pain scores were lower at 6, 12, and 24 hours (p < 0.05). Quadriceps strength remained intact in both groups. No nerve injuries were observed (p > 0.9999). Blood glucose levels at 12, 24, and 48 hours showed no significant differences between groups (p > 0.05), as seen in table 1.Conclusions Perineural dexamethasone effectively prolongs PENG block duration, reduces opioid consumption, and does not compromise motor function, nerve integrity, or glycemic control. It is a promising strategy for optimizing pain control in elderly THA patients.Abstract OP02 Table 1Primary and secondary outcomes- part 1Abstract OP02 Table 2Primary and secondary outcomes- part 2