1
|
Girón-Arango L, Peng P. Spread of injectate in pericapsular nerve group block: a Rashomon effect? Reg Anesth Pain Med 2024:rapm-2024-105870. [PMID: 39106987 DOI: 10.1136/rapm-2024-105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Laura Girón-Arango
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip Peng
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Pai P, Amor D, Lai YH, Echevarria GC. Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:320-332. [PMID: 38268183 DOI: 10.1097/ajp.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Ultrasound-guided pericapsular nerve group (PENG) block is an emerging regional anesthesia technique that may provide analgesia for patients undergoing total hip arthroplasties (THA). There are clinical studies comparing this fascial plane block to other established methods; however, evidence on the actual efficacy of this block for THA continues to evolve. OBJECTIVE Available clinical studies conducted over the past 4 years were reviewed to evaluate the analgesic efficacy and effectiveness of PENG block in patients undergoing THAs. METHODS A meta-analysis of randomized controlled trials (RCTs) in patients undergoing THA, where PENG block was compared to no block, placebo/sham block (injection with saline), or other analgesic techniques including suprainguinal fascia iliaca block (FIB), or periarticular infiltration (PAI) was performed. Our primary outcome was opioid consumption during the first 24 hours. Secondary outcomes were postoperative rest and dynamic pain scores at 6-12, 24 and 48 hours, block performance time, sensory-motor assessment, quadriceps weakness, the incidence of postoperative falls, first analgesic request, block and opioid-related complications, surgical complications, patient satisfaction scores, postanesthesia care unit length of stay, hospital length of stay, and functional and quality of life outcomes. RESULTS We included 12 RCTs with a total of 705 patients. Data showed that PENG block decreased 24-hour oral morphine milligram equivalent consumption by a mean difference (MD) of 3.75 mg (95% CI: -5.96,-1.54; P =0.0009). No statistically significant differences in rest or dynamic pain were found, except for a modest MD reduction in dynamic pain score of 0.55 points (95% CI: -0.98, -0.12; P =0.01), measured 24 hours after surgery in favor of PENG block. CONCLUSIONS Our systematic review and meta-analysis suggest that PENG block provides better analgesia, measured as MME use, in the first 24 hours after THA, with no real impact on postoperative VAS scores. Despite statistical significance, the high heterogeneity across RCTs implies that PENG's benefits may not surpass the minimal clinically important difference threshold for us to recommend PENG as best practice in THA.
Collapse
Affiliation(s)
- Poonam Pai
- Icahn School Of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside Hospitals, NY
| | | | | | | |
Collapse
|
3
|
Iacovazzo C, Sara R, Buonanno P, Vargas M, Coviello A, Punzo R, Maffei V, Marra A. The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study. Diagnostics (Basel) 2024; 14:827. [PMID: 38667473 PMCID: PMC11049482 DOI: 10.3390/diagnostics14080827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods. METHODS We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon-Mann-Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h. RESULTS the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up. CONCLUSION the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis.
Collapse
Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Rosario Sara
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| | - Roberta Punzo
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Vincenzo Maffei
- U.O.S.C. Postoperative Intensive Care and Hyperbaric Oxygen Therapy—Election Anaesthesiological Activity in AORN “A. Cardarelli”, Via A. Cardarelli 9, 80131 Naples, Italy; (R.S.); (R.P.); (V.M.)
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy; (P.B.); (A.C.); (A.M.)
| |
Collapse
|
4
|
Eshag MME, Hasan LOM, Elshenawy S, Ahmed MS, Emad Mostafa AEM, Abdelghafar YA, Althawadi YJ, Ibraheem NM, Badr H, AbdelQadir YH. Fascia iliaca compartment block for postoperative pain after total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2024; 24:95. [PMID: 38459449 PMCID: PMC10924383 DOI: 10.1186/s12871-024-02476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Fascia iliaca compartment block (FICB) is one of the regional nerve blocks used to reduce pain after total hip arthroplasty (THA). We aim to assess the efficacy of FICB in reducing post-operative pain and opioid consumption. METHODS We searched PubMed, Web of Science, Cochrane Library, Embase, and Scopus on February 19, 2023, and we updated our search in august 2023 using relevant search strategy. Studies were extensively screened for eligibility by title and abstract screening, followed by full-text screening. We extracted the data from the included studies, and then pooled the data as mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI), using Review Manager Software (ver. 3.5). RESULTS FIBC significantly reduced analgesic consumption at 24 h (MD = -8.75, 95% CI [-9.62, -7.88] P < 0.00001), and at 48 h post-operatively. (MD = -15.51, 95% CI [-26.45, -4.57], P = 0.005), with a significant sensory block of the femoral nerve (P = 0.0004), obturator nerve (P = 0.0009), and lateral femoral cutaneous nerve (P = 0.002). However, FICB was not associated with a significant pain relief at 6, 24, and 48 h postoperatively, except at 12 h where it significantly reduced pain intensity (MD = -0.49, 95% CI [-0.85, -0.12], P = 0.008). FICB was also not effective in reducing post-operative nausea and vomiting (MD = 0.55, 95% CI [0.21, 1.45], P = 0.23), and was associated with high rates of quadriceps muscle weakness (OR = 9.09, % CI [3.70, 22.30], P = < 0.00001). CONCLUSIONS FICB significantly reduces the total analgesic consumption up to 48 h; however, it is not effective in reducing post-operative pain, nausea and vomiting and it induced postoperative muscle weakness.
Collapse
Affiliation(s)
| | | | - Salem Elshenawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | | | | | | | - Helmy Badr
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | |
Collapse
|
5
|
Andrade PP, Lombardi RA, Marques IR, Braga ACDNAE, Isaias BRS, Heiser NE. Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:794-809. [PMID: 37507071 PMCID: PMC10625158 DOI: 10.1016/j.bjane.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. METHODS Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. CONCLUSION The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO REGISTRATION CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.
Collapse
Affiliation(s)
- Priscila P Andrade
- Hospital Regional de Sorocaba Adib Domingos Jatene, Divisão de Anestesiologia, Sorocaba, SP, Brazil
| | - Rafael A Lombardi
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America.
| | - Isabela R Marques
- Universitat Internacional de Catalunya, Division of Medicine, Barcelona, Spain
| | | | - Beatrice R S Isaias
- Universidade Federal de Mato Grosso do Sul, Divisão de Medicina, Campo Grande, MS, Brazil
| | - Nicholas E Heiser
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America
| |
Collapse
|
6
|
Chaudhary K, Bose N, Tanna D, Chandnani A. Ultrasound-guided pericapsular nerve group (PENG) block versus femoral nerve block for positioning during spinal anaesthesia in proximal femur fractures: A randomised comparative study. Indian J Anaesth 2023; 67:913-919. [PMID: 38044928 PMCID: PMC10691599 DOI: 10.4103/ija.ija_553_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims Femoral nerve block is a widely used analgesia technique for positioning before spinal anaesthesia for proximal femur fracture surgeries. Pericapsular nerve group (PENG) block is a newer technique with motor-sparing characteristics. We compared the analgesic efficacy of these blocks for patient positioning for spinal anaesthesia. Methods In this study, 60 patients were randomised to either the PENG group (n = 30) or the femoral group (n = 30). After performing the block, the pain was assessed every 10 min using a visual analogue scale (VAS) score for 30 min. The primary objective was the median [interquartile range (IQR)] reduction in pain (dynamic VAS with 15-degree passive limb elevation) at 30 min. Secondary objectives were ease of spinal position score (EOSP), angle obtained during positioning, duration of postoperative analgesia and quadriceps weakness. Results The demographics were comparable in both groups. After 30 min, the median (IQR) VAS was 6 (5-7) in the PENG group and 5 (5-6) in the femoral group (P = 0.004). Secondary outcomes such as EOSP score and angle obtained by patients were comparable. In the postoperative period, patients had significantly lower pain in the PENG group compared to the femoral group. The duration of analgesia was prolonged with PENG block. Quadriceps weakness was significantly low with PENG block (P < 0.001). Conclusion PENG block provides better analgesia than a femoral block before spinal anaesthesia for proximal femur fracture surgery. The postoperative duration of analgesia was also longer.
Collapse
Affiliation(s)
- Kinjal Chaudhary
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Neeta Bose
- Department of Emergency Medicine, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Dhara Tanna
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Anup Chandnani
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
| |
Collapse
|
7
|
Zheng C, Hou Z, Wang T, Yi L, Chen Y. Impact of multimodal analgesia on postoperative anxiety and depression following total knee arthroplasty. J Orthop Surg Res 2023; 18:712. [PMID: 37735386 PMCID: PMC10515006 DOI: 10.1186/s13018-023-04192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Postoperative pain after total knee arthroplasty (TKA) can cause negative emotions, such as anxiety and depression, which can severely affect a patient's long-term quality of life. OBJECTIVE This study aimed to investigate the impact of multimodal analgesia (MMA) on postoperative anxiety and depression following total knee arthroplasty. METHODS This study included 161 patients who underwent TKA from October 2020 to October 2022 in the First Affiliated Hospital of Wannan Medical College, including 79 cases in the control group and 82 cases in the multimodal analgesia group (MMA). The MMA group were administered acetaminophen 0.5 g/d orally 3 days before the surgery, and an ultrasound-guided fascia iliac compartment block (FICB) with 0.25% ropivacaine 30 ml in the inguinal region ipsilateral to the surgery was performed 1 h before surgery. After the surgery, 100 ml solution includes 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Postoperative conventional intravenous analgesia was used in the control group, including 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Patients were scored for pain, anxiety, and depression in the ward at 3 and 7 days postoperatively, and postoperative patients were scored using telephone callbacks at 3 months postoperatively. RESULTS It was found that the visual analog scale (VAS) scores for pain at rest at 3 days, 7 days, and 3 months postoperatively were significantly lower in the MMA group than in the control group (P < 0.05). The scores for pain with movement were significantly lower in the MMA group than in the control group at 3 days and 7 days postoperatively (P < 0.01), but they were similar at 3 months postoperatively. Compared to the control group, the MMA group had significantly higher American Knee Society scores (AKS) at 3 days, 7 days, and 3 months postoperatively (P < 0.05). Compared to the control group, the MMA group had significantly higher Lower Extremity Functional Scale and Hospital Anxiety and Depression Scale scores (HADS) (P < 0.05) at 3 days and 7 days postoperatively; compared to the control group, the MMA group had a significantly shorter hospital stay (P < 0.01). CONCLUSION Multimodal analgesia can alleviate postoperative anxiety and depression in the short term, reduce perioperative pain, improve postoperative recovery, and shorten the length of hospital stay.
Collapse
Affiliation(s)
- Changjian Zheng
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Zijun Hou
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Tingting Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Lingmei Yi
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Yongquan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China.
| |
Collapse
|
8
|
Doğan K, Keçe C. Comparison of the results of stop-start technique with stop-start technique and sphincter control training applied in premature ejaculation treatment. PLoS One 2023; 18:e0283091. [PMID: 37561708 PMCID: PMC10414676 DOI: 10.1371/journal.pone.0283091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the results of stop-start technique with stop-start technique together with sphincter control training applied in the treatment of premature ejaculation. METHODS This research was conducted as a pre-test post-test quasi-experimental study. The sample of the study consisted of 80 men. The study was conducted on men who applied to the urology outpatient clinic of LIV Hospital, a prıvate hospital, in Gaziantep, Turkey, between 01 October 2021 and 01 March 2022. "Personal Information Form", "Intravaginal Ejaculation Latency Time (IELT)", "Fold Increase Intravaginal Ejaculation Latency Time (F-IELT)" "Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire" and "Arabic Index Premature Ejaculation (AIPE)" were used as the data collection tools. Behavioral therapy, consisting of a total of 6 sessions, was applied once every two weeks, with each session lasting for 45 minutes. After 3rd and 6th months from the beginning of the application, the data collection tools were applied again. "Stop-Start Technique (Group A)" and "Stop-Start Technique and Sphincter Control Training (Group B)" were used in the treatment. RESULTS In both groups, the IELT and AIPE values after 3rd and 6th months from the beginning of the application were statistically higher than those obtained before (p<0.05). IELT and AIPE values increased more in Group B than Group A (p<0.05). F-IELT values after 6th months from the beginning of the application were found to be statistically significant with a low level of effect size than those obtained before (p<0.05, Cohen's d = 0.027). In both groups, the PEDT values in the 3rd and 6th months after the application were statistically lower than those seen before (p<0.05). PEDT value decreased more in Group B than Group A (p<0.05). The differences between the two groups' IELT (Cohen's d = 0.011), AIPE (Cohen's d = 0.044), and PEDT (Cohen's d = 0.066) values in the 3rd month after the application and IELT (Cohen's d = 0.025), AIPE (Cohen's d = 0.048), and PEDT (Cohen's d = 0.024) values in the 6th month after the application were found to be clinically weak. CONCLUSIONS It was determined that the stop-start technique given to men with premature ejaculation increased the time spent in the vagina and eliminated the problem of premature ejaculation. It was determined that the stop-start technique in combination with sphincter control training were more effective than the stop-start technique alone.
Collapse
Affiliation(s)
- Kazım Doğan
- Urologist, Istinye University, Istanbul, Turkey
| | - Cem Keçe
- Psychotherapist, President of IICPI, Ankara, Turkey
| |
Collapse
|
9
|
Ten Hoope W, Smulders PSH, Baumann HM, Hermanides J, Beenen LFM, Oostra RJ, Marhofer P, Lirk P, Hollmann MW. A radiological cadaveric study of obturator nerve involvement and cranial injectate spread after different approaches to the fascia iliaca compartment block. Sci Rep 2023; 13:12070. [PMID: 37495606 PMCID: PMC10372149 DOI: 10.1038/s41598-023-39041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
Whether the fascia iliaca compartment block (FICB) involves the obturator nerve (ON) remains controversial. Involvement may require that the injectate spreads deep in the cranial direction, and might thus depend on the site of injection. Therefore, the effect of suprainguinal needle insertion with five centimeters of hydrodissection-mediated needle advancement (S-FICB-H) on ON involvement and cranial injectate spread was studied in this radiological cadaveric study. Results were compared with suprainguinal FICB without additional hydrodissection-mediated needle advancement (S-FICB), infrainguinal FICB (I-FICB), and femoral nerve block (FNB). Seventeen human cadavers were randomized to receive ultrasound-guided nerve block with a 40 mL solution of local anesthetic and contrast medium, on both sides. Injectate spread was objectified using computed tomography. The femoral and lateral femoral cutaneous nerves were consistently covered when S-FICB-H, S-FICB or FNB was applied, while the ON was involved in only one of the 34 nerve blocks. I-FICB failed to provide the same consistency of nerve involvement as S-FICB-H, S-FICB or FNB. Injectate reached most cranial in specimens treated with S-FICB-H. Our results demonstrate that even the technique with the most extensive cranial spread (S-FICB-H) does not lead to ON involvement and as such, the ON seems unrelated to FICB. Separate ON block should be considered when clinically indicated.
Collapse
Affiliation(s)
- Werner Ten Hoope
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Pascal S H Smulders
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Holger M Baumann
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Philipp Lirk
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Duan L, Zhang L, Shi CG, Huang LG, Ao H, Wang ZP, Deng Y, Sun ML. Comparison of continuous pericapsular nerve group (PENG) block versus continuous fascia iliaca compartment block on pain management and quadriceps muscle strength after total hip arthroplasty: a prospective, randomized controlled study. BMC Anesthesiol 2023; 23:233. [PMID: 37434138 DOI: 10.1186/s12871-023-02190-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND This investigation aimed to evaluate the impact of continuous pericapsular nerve group (PENG) block and continuous fascia iliac compartment block (FICB) on postoperative pain following total hip arthroplasty (THA). METHODS This prospective, randomized, and controlled trial recruited a cohort of fifty-seven patients with unilateral femoral neck fractures from Xi'an Aerospace General Hospital in northwest China between July 2020 and November 2021. These patients were randomly assigned to two groups: the continuous PENG block group (PENG group, n = 29) and the continuous FICB group (FICB group, n = 28). Under ultrasound guidance, PENG block and FICB procedures were performed prior to spinal anesthesia, utilizing 20 ml of 0.25% ropivacaine for PENG block and 30 ml of 0.25% ropivacaine for FICB. Subsequently, a catheter was inserted. All study participants received a standardized postoperative multimodal analgesic regimen, including intravenous administration of 30 mg Ketorolac tromethamine every eight hours and patient-controlled neural analgesia (PCNA) after surgery. Numerical rating scale (NRS) scores at rest and during exercise were recorded at various time points: prior to block (T0), 30 min post-blockade (T1), and 6 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) postoperatively. Additional data collected encompassed postoperative quadriceps muscle strength, the time of initial ambulation after surgery, the number of effective PCNA activations, rescue analgesia requirements, and occurrences of adverse events (such as nausea and vomiting, hematoma, infection, catheter detachment, or displacement) within 48 h following surgery. RESULTS In the PENG group, the resting NRS pain scores exhibited lower values at T1, T4, and T5 than those at T0. Furthermore, exercise NRS pain scores at T1-T5 were lower in the PENG group than in the FICB group. Similarly, during the same postoperative period, the PENG group demonstrated enhanced quadriceps strength on the affected side compared to the FICB group. Additionally, the PENG group displayed earlier postoperative ambulation and reduced occurrences of effective PCNA activations and rescue analgesia requirements compared to the FICB group. CONCLUSION Continuous PENG block exhibited superior analgesic efficacy after THA compared to continuous FICB, promoting recovery of quadriceps strength on the affected side and facilitating early postoperative ambulation. TRIAL REGISTRATION This clinical trial was registered in the China Clinical Trials Center ( http://www.chictr.org.cn ) on 20/07/2020, with the registration number ChiCTR2000034821.
Collapse
Affiliation(s)
- Lei Duan
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Liang Zhang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Chuang-Guo Shi
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Li-Gang Huang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Hui Ao
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Ze-Peng Wang
- Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an, China
| | - Yue Deng
- Department of Joint Surgery, Xi 'an Aerospace General Hospital, Xi'an, China
| | - Meng-Liang Sun
- Intensive Care Medicine Center of Xi'an People's Hospital, No. 155, Cross of East Aero-East Road and Hangkai Road, Chang'an District, Xi'an City, 710100, Shaanxi Province, China.
| |
Collapse
|
11
|
Kim JY, Kim J, Kim DH, Han DW, Kim SH, Kim D, Chung S, Yu S, Lee UY, Park HJ. Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block. Anesth Analg 2023; 136:597-604. [PMID: 36727847 DOI: 10.1213/ane.0000000000006364] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The pericapsular nerve group (PENG) block was recently suggested as a regional technique for managing acute pain after hip surgery. However, few anatomical studies have confirmed the spread of injectate during the PENG block. This cadaver study aimed to analyze injectate spread to the target nerves during single-injection ultrasound-guided PENG block. METHODS Ultrasound-guided PENG block with 3 different injectate volumes (10, 20, or 30 mL) was performed in 18 cadavers. Injectate spread by the volume was first evaluated on computed tomography, followed by cadaver dissection. The spread of the dye over the pelvis and lower limb was evaluated. RESULTS The articular branches of the femoral nerve were stained nearly sufficiently with 20- and 30-mL specimens. The femoral nerve itself was stained simultaneously in six of 12 (50%) 20-mL specimens and 12 of 12 (100%) 30-mL specimens. The accessory obturator nerve was observed only in three (9%) of 36 specimens. The articular branches of the obturator nerve were rarely affected, regardless of injectate volume (1/12, 10 mL specimens; 2/12, 20 mL specimens; 1/12, 30 mL specimens; P > .999). Rather, the obturator nerve was affected. However, the obturator nerve was not stained consistently even with 30 mL of injectate (50%). CONCLUSIONS After combining the dissection and radiological findings, the single-injection ultrasound-guided PENG blocks with volumes of 10, 20, and 30 mL do not support motor sparing or selective anterior hip capsule innervation in a clinical setting. If early rehabilitation is needed, high-volume PENG block might not be the ideal option, and persisting pain after PENG block might be attributed in part to the lack of obturator nerve articular branches blockade.
Collapse
Affiliation(s)
- Ji Yeong Kim
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jiyoung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do-Hyeong Kim
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Dong Woo Han
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Sang Hyun Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Donghyun Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siwook Chung
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sanghyuck Yu
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Young Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
12
|
Farag A, Hendi NI, Diab RA. Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis. J Anesth 2023; 37:138-153. [PMID: 36342537 PMCID: PMC9870839 DOI: 10.1007/s00540-022-03129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Perioperative pain management related to hip surgical procedures is challenging. Pericapsular nerve group (PENG) block is a novel technique that is assumed to provide better analgesia in addition to its post-operative motor-sparing effect. In this review, we aim to assess the safety and efficacy of PENG block on pain management in patients undergoing hip surgeries. Fifteen clinical trials with a total of 837 patients were included. Pain scores favored PENG group when compared to FICB group (fascia iliaca compartment block) or analgesics-only group, but the difference could only be detected in the early post-operative period. Afterward, it seems to lose its superiority, and no difference could be detected. In addition, cumulative opioid consumption favored PENG group at 24 h but not at 48 h. Regarding patients' satisfaction, our analysis showed results favoring PENG group, but there was no difference in time to first opioid or length of hospital stay. The incidence of vomiting was lower in PENG, but there was no difference in the incidence of nausea, pruritis, and dizziness. PENG provides better analgesia and lower opioid consumption in the initial post-operative period. Current evidence is not enough, and further high-quality randomized controlled trials with larger sample sizes are required.
Collapse
Affiliation(s)
- Ahmed Farag
- Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
| | | | | |
Collapse
|
13
|
He WQ, Li YJ, Li YS, Zhang XH, Cao J, Lu KZ, Cheung CW, Gu JT, Xia ZY, Yi B. Advantages of Transmuscular Quadratus Lumborum Block via Subfascial Approach Versus Extrafascial Approach for Postoperative Analgesia After Laparoscopic Cholecystectomy: A Randomized Controlled Study. Clin J Pain 2022; 38:730-738. [PMID: 36221155 PMCID: PMC9645534 DOI: 10.1097/ajp.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/22/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC). METHODS Eighty patients undergoing LC were randomized to receive ultrasound-guided bilateral TQL block via subfascial (subfascial group) or extrafascial (extrafascial group) using 30 mL of 0.33% ropivacaine unilaterally. Pain scores of port sites while rest and coughing at 1, 6, 12, 24, 36, and 48 hours postoperatively as primary outcome were compared. Modified Lovett Rating Scale, ambulatory dependency, and rescue analgesia requirement was also compared. RESULTS The pain score of the subxiphoid and of the right subcostal port site for up to the postoperative 36 hours (2 [1 to 2]) and 24 hours (2 [2 to 3]) in the subfascial group was significantly lower than that in extrafascial group (2 [2 to 2] and 3 [2.25 to 4]). Up to postoperative 24 hours, the rescue analgesia requirement in subfascial group was significantly lower than that in extrafascial group, namely less fentanyl consumption and parecoxib (1.3 [±5.5] μg vs. 5.6 [±10.6] μg; 17.5% vs. 37.5%). The ratio of patients with LRS score of 6 at postoperative 1 hour (65.0%), and with dependent ambulation at postoperative 1 and 6 hours in subfascial group (15.0% and 0.0%) was significantly lower than that in extrafascial group (10.0%, 80.0%, and 17.5%). CONCLUSION TQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.
Collapse
Affiliation(s)
- Wen-quan He
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yu-jie Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yong-shuai Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Xu-hao Zhang
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Jian Cao
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Kai-zhi Lu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, University of Hong Kong, HKSAR
| | - Jian-teng Gu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Zheng-yuan Xia
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bin Yi
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| |
Collapse
|
14
|
Kaur G, Saikia P, Dey S, Kashyap N. Pericapsular nervegroup (PENG) block—a scoping review. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2022. [PMCID: PMC8919174 DOI: 10.1186/s42077-022-00227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The obturator nerve and its accessory branch supplying the hip region, unlike the femoral nerve, are not adequately anaesthetized by conventional regional anaesthetic techniques targeting the hip region. With advancements in ultrasound-guided regional anaesthetic techniques, interests are revived in the field and efforts are being made to block them together. One such successful attempt is the novel peri-capsular nerve group (PENG) block. Consequently, further research on the PENG block began to explore its versatilities. The present study undertakes a scoping review of research on the PENG block in humans for any indication to determine the extent of the research done, the methodologies used, and other practical issues addressed in the research. This will help to identify potential research gaps that should be addressed in the future. PubMed, Google Scholar, Cochrane Library, KoreaMed, Latin American and Caribbean Health Science Literature, and the directory of open access journals were searched with the keyword “PENG block” and “pericapsular nerve group”. Manual search of electronically retrieved papers was also carried out. Among the 67 articles selected in our review, eighteen are case series; twenty-nine are case reports; two are randomized studies; one each of prospective cohort study, review, and cadaveric study; and 15 are editorials. However, only 64 articles were included later due to the retraction of three case reports. Data is insufficient to provide firm recommendations for or against different aspects of the block. The review encourages future work addressing different aspects of the PENG block.
Collapse
|
15
|
Fahey A, Cripps E, Ng A, Sweeny A, Snelling PJ. Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study. Emerg Med Australas 2022; 34:884-891. [PMID: 35701386 PMCID: PMC9796647 DOI: 10.1111/1742-6723.14013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The pericapsular nerve group (PENG) block was first described for analgesia of hip fracture in 2018. We hypothesised that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the ED. METHODS This was an observational study of routine care. Consecutive patients receiving regional anaesthesia for hip fracture at a single ED were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 min after administration. Maximal reduction in pain scores within 60 min were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 h after regional anaesthesia and adverse events over the duration of admission. RESULTS There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 fascia iliaca compartment blocks, 14 femoral nerve blocks) and 19 received a PENG block. Inexperienced providers were able to successfully perform the PENG block. There was no difference in maximum pain score reduction between the groups. There was no difference in adverse effects between groups. Opioid use was similar between the groups. More patients were opioid-free after a PENG block. CONCLUSIONS The present study demonstrated that the PENG block can be provided safely and effectively to patients with hip fracture in the ED. On the basis of this pilot study, a larger randomised controlled study should now be designed.
Collapse
Affiliation(s)
- Alan Fahey
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia
| | - Elinor Cripps
- Department of AnaesthesiaLismore Base HospitalLismoreNew South WalesAustralia
| | - Aloysius Ng
- Department of Acute Care MedicineFiona Stanley HospitalPerthWestern AustraliaAustralia
| | - Amy Sweeny
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and Medicine, Bond UniversityGold CoastQueenslandAustralia
| | - Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Sonography Innovation and Research GroupGold CoastQueenslandAustralia,Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
16
|
Kong M, Tang Y, Tong F, Guo H, Zhang XL, Zhou L, Ni H, Wang B, Liu Y, Liu J. The analgesic efficacy of pericapsular nerve group block in patients with intertrochanteric femur fracture: A randomized controlled trial. PLoS One 2022; 17:e0275793. [PMID: 36227845 PMCID: PMC9562218 DOI: 10.1371/journal.pone.0275793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this study is to evaluate analgesic efficacy of pericapsular nerve group (PENG) block in patients with intertrochanteric femur fracture (IFF). Methods This double-blinded randomized controlled trial in patients with IFF scheduled for proximal femoral nail antirotation (PFNA) between December 2020 and November 2021. The primary outcome was VAS scores during exercising at 6 h after surgery; secondary outcomes were pain during exercising and rest, intraoperative dose of remifentanil, cumulative dose of postoperative fentanyl, postoperative analgesia satisfaction scores, and ratio of quadriceps weakness. Results A total of 50 patients were randomly divided into PENG block group (n = 25) or fascia iliaca compartment block (FICB) group (n = 25). Exercising VAS scores at 6 h after surgery were significantly lower in PENG block group than that in FICB group (2 (2, 4) vs. 6 (4, 7), P < 0.001). The intraoperative dose of remifentanil and cumulative dose of postoperative fentanyl by patient-controlled intravenous analgesia within 24 h after surgery in PENG block group were significantly lower than in FICB group (both P < 0.001). Postoperative analgesia satisfaction scores in PENG block group were significantly higher than those in FICB group (P = 0.016). The ratio of quadriceps weakness at 6 h after surgery was significantly higher in FICB group than PENG block group (48% vs. 0%, P < 0.001). Conclusions Compared to FICB, ultrasound-guided PENG block may provide better postoperative pain relief in patients with IFF, with less pronounced quadriceps weakness.
Collapse
Affiliation(s)
- Mingjian Kong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
- * E-mail:
| | - Yan Tang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Fei Tong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Hui Guo
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xin Lei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Lei Zhou
- Department of Orthopaedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Hua Ni
- Department of Rehabilitation, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Bin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yunqing Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Jindong Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| |
Collapse
|
17
|
Gong WY, Fan K. A novel anterior approach for ultrasound-guided lumbar plexus combined with sacral plexus blocks with one-point puncture. Response to Br J Anaesth 2022; 129: e71-e72. Br J Anaesth 2022; 129:e131-e132. [PMID: 36028391 DOI: 10.1016/j.bja.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Wen-Yi Gong
- Department of Anaesthesiology, Wusong Branch, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Kun Fan
- Department of Anaesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
| |
Collapse
|
18
|
Ultrasound guided Fascia Iliaca Block versus Pericapsular Nerve Group for Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
For evaluating per capsular nerve group (PENG) block’s analgesic effect on elderly patient’s suffering from femoral neck fracture undergoing hip arthroplasty to provide a basis for optimizing perioperative analgesia in hip arthroplasty. This is a Prospective Observational study conducted in patients scheduled to undergo surgery for hip fracture under spinal anesthesia in Department of Anaesthesiology, Sapthagiri Institute of Medical Sciences and Research centre, Bengaluru, Karnataka. As per previous studies a total of 40 patients were included in the study over a period of 6 months. A prospective study was conducted after obtaining approval by the institutional ethics committee and informed written consent, patient scheduled for hip fracture surgery under spinal anesthesia based on inclusion criteria was randomly divided into two groups as group FIB and group PENG. Total 40 patients were included in the current study. The demographic data of both the groups are presented. There was no statistically significant difference in both groups with respect to demographic characteristics. VAS score for pain before nerve block between Group P (8.4 ± 0.58) and Group F (8.1 ± 0.61) was comparable (p = 0.9983).
Collapse
|
19
|
Luo W, Liang J, Wu J, Luo Q, Wu H, Ou Y, Li Y, Ma W. Effects of pericapsular nerve group (PENG) block on postoperative recovery in elderly patients with hip fracture: study protocol for a randomised, parallel controlled, double-blind trial. BMJ Open 2022; 12:e051321. [PMID: 35351697 PMCID: PMC8966559 DOI: 10.1136/bmjopen-2021-051321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hip fracture is a common and serious emergency in the elderly, and it is associated with severe pain, significant morbidity and mortality. The use of peripheral nerve block can relieve pain effectively and reduce opioid requirements, which may accelerate patient's recovery. The pericapsular nerve group (PENG) block has been found to provide an effective blockade to the hip joint with a potential motor-sparing effect, so we hypothesised that the PENG block may be an effective tool to enhance the recovery in elderly patients after hip fracture surgery. METHODS AND ANALYSIS This study is a single-centred, randomised, parallel controlled, double-blind trial. A total of 92 elderly patients scheduled for hip fracture surgery will be divided into two groups at random to receive either ultrasound-guided femoral nerve block or ultrasound-guided PENG block. The primary outcome will be to compare the Quality of Recovery-15 scores at 24 hours postoperatively between the two groups. The secondary outcomes will include measuring and comparing the strength of the quadriceps, the visual analogue scale at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilisation and complications. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (reference K2020-110). The results of this study will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER ChiCTR2100042341.
Collapse
Affiliation(s)
- Wei Luo
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianhui Liang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jieting Wu
- Department of Anesthesiology, The Third People's Hospital of Guangzhou Baiyun District, Guangzhou, Guangdong, China
| | - Quehua Luo
- Department of Anesthesiology, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huiyi Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanhua Ou
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - WuHua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
20
|
Hua H, Xu Y, Jiang M, Dai X. Evaluation of Pericapsular Nerve Group (PENG) Block for Analgesic Effect in Elderly Patients with Femoral Neck Fracture Undergoing Hip Arthroplasty. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7452716. [PMID: 35186238 PMCID: PMC8849892 DOI: 10.1155/2022/7452716] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND For evaluating pericapsular nerve group (PENG) block's analgesic effect on elderly patients suffering from femoral neck fracture undergoing hip arthroplasty to provide a basis for optimizing perioperative analgesia in hip arthroplasty. METHODS Forty-eight patients undergoing hip arthroplasty with spinal anesthesia for femoral neck fracture in our hospital were chosen in this study. Based on the random number table method, patients were categorized into the following two groups (n = 24 per group): the hip peripheral nerve group block group (PE group) and the iliac fascia block group (FI group). The fascia iliaca compartment block was used in the FI group, whereas the pericapsular nerve group block in the PE group. When placed in the position for spinal anesthesia (T4), we measured dynamic and static visual analog scale (VAS) scores as well as analgesic satisfaction before blockade (T0), along with at 10 min (T1), 20 min (T2), and 30 min postblockade (T3). Sufentanil dosage and effective analgesic pump press number at 6 h (T5), 12 h (T6), 24 h (T7), and 48 h (T8) postoperatively were recorded. In the meantime, the development of related complications was also recorded. RESULTS Compared with T0, patients in both groups achieved lower static VAS scores at T1-T4 (P < 0.05) and lower dynamic VAS scores at T2-T4 of the FI group (P < 0.05). Relative to the FI group, both static and dynamic VAS scores at T1-T4 were obviously lower in the PE group (P < 0.05), along with increased dynamic analgesic satisfaction (P < 0.05). Weakness of the quadriceps was observed in seven patients in the FI groups (P < 0.05). No delirium, hematoma, puncture site infection, or nerve injury occurred in either group. CONCLUSION The pericapsular nerve group block can provide safe and effective analgesia for elderly patients during the perioperative period of hip arthroplasty, with rapid onset, good analgesic effect, high patient satisfaction, and low complication rate, and is worthy of widespread application. The trial is registered with ChiCTR2100046785.
Collapse
Affiliation(s)
- Hao Hua
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - Yan Xu
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - MengLu Jiang
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - Xu Dai
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| |
Collapse
|
21
|
Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
Collapse
Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| |
Collapse
|
22
|
Chen L, Shen Y, Liu S, Cao Y, Zhu Z. Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial. BMC Geriatr 2021; 21:669. [PMID: 34852764 PMCID: PMC8638559 DOI: 10.1186/s12877-021-02646-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia. Methods We performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure—as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented. Results A total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups. Conclusions The supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach. Trial registration The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).
Collapse
Affiliation(s)
- Liang Chen
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yang Shen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
| | - Shuangmei Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yanyan Cao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhe Zhu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| |
Collapse
|
23
|
Maniar A, Macachor J, Chiew WLA, Kumar CM, Imani F, Rokhtabnak F. Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist. Anesth Pain Med 2021; 11:e116099. [PMID: 34692438 PMCID: PMC8520681 DOI: 10.5812/aapm.116099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The article described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.
Collapse
Affiliation(s)
- Amjad Maniar
- Department of Anaesthesia, Satya Sai Orthopaedic and Multispecialty Hospital, Bengaluru, India
| | - Joselo Macachor
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
| | | | - Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
24
|
Tarekegn F, Sisay A. A review of evidence-based clinical practice on fascia iliaca compartment block for lower limb injury. Ann Med Surg (Lond) 2021; 69:102758. [PMID: 34484728 PMCID: PMC8391022 DOI: 10.1016/j.amsu.2021.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The main objective of this study was to resolve fascia iliaca compartment block controversies by putting the currently available evidences applied for knee, femoral shaft, and hip bone injury or related to surgery. METHODS The databases PubMed, Cochrane Review, and Google Scholar were searched without regard to language or publication type for fascia iliaca compartment block before December 2020. After eligibility sorting and duplicate removal, a total of 26,609 articles were identified, with 21 of them being included for review. DISCUSSION In the emergency department, fascia iliaca compartment block (FICB) has now become the standard of practice. Various evidence suggested that 20-40 ml of local anesthetic was required for an effective block in adult patients. CONCLUSION For the knee, femoral bone, and hip region surgery, the fascia iliaca compartment block (FICB) provided better anesthesia quality, reduced systemic morphine consumption, and had fewer complications than epidural anesthesia. Anesthetists and surgical department staff should promote the FICB's benefits by emphasizing its superiority in pain management.
Collapse
Affiliation(s)
| | - Amanuel Sisay
- Department of Anesthesia, Bahir Dar University, Ethiopia
| |
Collapse
|
25
|
Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
Collapse
Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
26
|
Shamim R, Prasad G, Bais PS, Priya V, Singh TK, Ambasta S, Philips AK. Ultrasound-Guided Suprainguinal Fascia Iliaca Compartment Block for Postoperative Analgesia in Patients Undergoing Hip and Femur Surgeries: A Retrospective Analysis. Anesth Essays Res 2021; 14:525-530. [PMID: 34092870 PMCID: PMC8159042 DOI: 10.4103/aer.aer_9_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022] Open
Abstract
Context: Fractures of femur and hip surgeries pose a challenge because of excruciating pain. Fascia iliaca compartment block is an effective and easily learned procedure to decrease postoperative pain score and dosage of opioid. Many adjuvants are combined with local anesthetics to prolong the postoperative analgesia. Aims: The aim was to study duration of postoperative analgesia in terms of Numeric Rating Scale (NRS), number of times rescue analgesic used, any adverse effect, and patient satisfaction score. Settings and Design: Operation theatre of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Materials and Methods: The present study was retrospective study with 203 patients evaluated. Based on the combination of the anesthesia and drugs, study patients were divided into six groups. Pain scores were assessed at 6 hourly intervals for 24 h. Statistical Analysis Used: Kruskal–Wallis H-test used to compare NRS as well as age and duration of anesthesia. Chi-square test/Fisher's exact test used to compare the proportions. Results: Postoperative analgesia was comparable and insignificant (P > 0.05) at 0, 6, 12 h in all six groups. Better postoperative analgesia was observed with dexmedetomidine and dexamethasone as adjuvant at 18 h, dexmedetomidine as adjuvant in comparison to dexamethasone as adjuvant at 24 h. Rescue analgesia in postoperative period was required maximum in plain bupivacaine. Satisfaction levels were good and excellent in dexmedetomidine and dexamethasone as adjuvant. Conclusions: Addition of dexmedetomidine to bupivacaine provides longer duration, good quality postoperative analgesia, reduced requirement for rescue analgesic, lesser postoperative nausea and vomiting, and better satisfaction levels.
Collapse
Affiliation(s)
- Rafat Shamim
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ganpat Prasad
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prateek Singh Bais
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vansh Priya
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tapas Kumar Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Suruchi Ambasta
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhishek K Philips
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
27
|
Allard C, Pardo E, de la Jonquière C, Wyniecki A, Soulier A, Faddoul A, Tsai ES, Bonnet F, Verdonk F. Comparison between femoral block and PENG block in femoral neck fractures: A cohort study. PLoS One 2021; 16:e0252716. [PMID: 34086782 PMCID: PMC8177466 DOI: 10.1371/journal.pone.0252716] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described "Pericapsular Nerve Group (PENG) Block" with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. MATERIALS AND METHODS We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. RESULTS Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0-20] mg and 20 [0-50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). CONCLUSION In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.
Collapse
Affiliation(s)
- Céline Allard
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Pardo
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Christophe de la Jonquière
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Wyniecki
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annibal Faddoul
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Francis Bonnet
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| |
Collapse
|
28
|
Wang YL, Liu YQ, Ni H, Zhang XL, Ding L, Tong F, Chen HY, Zhang XH, Kong MJ. Ultrasound-guided, direct suprainguinal injection for fascia iliaca block for total hip arthroplasty: A retrospective study. World J Clin Cases 2021; 9:3567-3575. [PMID: 34046456 PMCID: PMC8130076 DOI: 10.12998/wjcc.v9.i15.3567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.
AIM To investigate whether ultrasound-guided, direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.
METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not. The time to tracheal extubation and time spent in the post-anesthesia care unit (PACU), intraoperative remifentanil dosage, fentanyl consumption in the PACU, postoperative cumulative fentanyl consumption within 48 h after operation, visual analogue scale at rest and during movement on the first and second days after surgery, and adverse reactions were compared.
RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study (block group, n = 16; no-block group, n = 15). The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group (all P < 0.05). Compared with the no-block group, the intraoperative remifentanil dosage was lower, the time to tracheal extubation and the time spent in the PACU were shorter in the block group (all P < 0.01). Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group (all P < 0.01). The incidence of dizziness was higher in the no-block group than in the block group (P = 0.037).
CONCLUSION Ultrasound-guided, direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.
Collapse
Affiliation(s)
- Ya-Li Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Yun-Qing Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Hua Ni
- Rehabilitation Department, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Xin-Lei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Li Ding
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Fei Tong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Hong-Ye Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Xin-Hua Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Ming-Jian Kong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| |
Collapse
|
29
|
Gola W, Bialka S, Owczarek AJ, Misiolek H. Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094891. [PMID: 34064427 PMCID: PMC8124308 DOI: 10.3390/ijerph18094891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/21/2022]
Abstract
Objective: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR). Design: A randomised, single-center, open-label study. Setting: A single hospital. The study was conducted from October 2018 to May 2019. Participants: In total, 109 patients were scheduled for elective total hip replacement. Interventions: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia. Measurements: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h. Main Results: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group. Conclusions: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used. Trial registration: ClinicalTrials.gov No. NCT04690647.
Collapse
Affiliation(s)
- Wojciech Gola
- Department of Anaesthesia and Intensive Care, Saint Lucas Hospital, Konskie 26-200, Poland
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce 25-369, Poland
- Correspondence: or (W.G.); (S.B.); Tel.: +48-504-606-247 (W.G.)
| | - Szymon Bialka
- Intensive Care and Emergency Medicine, Department of Anaesthesiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland;
- Correspondence: or (W.G.); (S.B.); Tel.: +48-504-606-247 (W.G.)
| | - Aleksander J. Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesiain, Katowice 40-055, Poland;
| | - Hanna Misiolek
- Intensive Care and Emergency Medicine, Department of Anaesthesiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-055, Poland;
| |
Collapse
|
30
|
Bendtsen TF, Pedersen EM, Moriggl B, Hebbard P, Ivanusic J, Børglum J, Nielsen TD, Peng P. Suprainguinal fascia iliaca block: does it block the obturator nerve? Reg Anesth Pain Med 2021; 46:832. [PMID: 33911023 DOI: 10.1136/rapm-2021-102712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Hebbard
- Department of Anesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Jason Ivanusic
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Philip Peng
- Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Bendtsen TF, Pedersen EM, Moriggl B, Hebbard P, Ivanusic J, Børglum J, Nielsen TD, Peng P. Anatomical considerations for obturator nerve block with fascia iliaca compartment block. Reg Anesth Pain Med 2021; 46:806-812. [PMID: 33911025 DOI: 10.1136/rapm-2021-102553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022]
Abstract
This report reviews the topographical and functional anatomy relevant for assessing whether or not the obturator nerve (ON) can be anesthetized using a fascia iliaca compartment (FIC) block. The ON does not cross the FIC. This means that the ON would only be blocked by an FIC block if the injectate spreads to the ON outside of the FIC. Such a phenomena would require the creation of one or more artificial passageways to the ON in the retro-psoas compartment or the retroperitoneal compartment by disrupting the normal anatomical integrity of the FI. Due to this requirement for an artificial pathway, an FIC block probably does not block the ON.
Collapse
Affiliation(s)
| | - Erik Morre Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, University of Melbourne, Wangaratta, Victoria, Australia
| | - Jason Ivanusic
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jens Børglum
- Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | | | - Philip Peng
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Tran DQ, Kantakam P, Maikong N, Sinthubua A, Mahakkanukrauh P, Leurcharusmee P. Reply to Dr Bendtsen and colleagues. Reg Anesth Pain Med 2021; 46:832-833. [PMID: 33911026 DOI: 10.1136/rapm-2021-102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- De Q Tran
- Department of Anesthesiology, St.Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Perada Kantakam
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Naraporn Maikong
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Sinthubua
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prangmalee Leurcharusmee
- Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand .,Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
33
|
Zheng T, Hu B, Zheng CY, Huang FY, Gao F, Zheng XC. Improvement of analgesic efficacy for total hip arthroplasty by a modified ultrasound-guided supra-inguinal fascia iliaca compartment block. BMC Anesthesiol 2021; 21:75. [PMID: 33691623 PMCID: PMC7944595 DOI: 10.1186/s12871-021-01296-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Fascia iliaca compartment block (FICB) is an anterior approach to the lumbar plexus block and provides the effective adjunctive analgesia for total hip arthroplasty (THA). Methods As a case series study, 28 patients (≥ 65 years old) with THA were received a modified in-plane ultrasound-guided supra-inguinal (S-FICB) as an analgesic adjunct to evaluate the analgesic effectiveness and the local anesthetic diffusion with magnetic resonance imaging (MRI). A combination of propofol and sufentanil was administered to conduct target-controlled infusion. Results The pain scores were 1 (0–4), 2 (1–5), 3 (1–6) and 3 (1–6) at 4, 8, 12, and 24 h. The cumulative opioids were 8 (8–12), 18 (16–32), 28 (24–54) and 66 (48–104) mg of i.v. morphine equivalents at 4, 8, 12, and 24 h. The patient-controlled analgesia (PCA) times were 0 (0–1), 1 (0–2), 2 (0–5) and 5 (3–8) at 4, 8, 12, and 24 h. In lateral, anterior and medial part of thigh, the sensory blockade in 28 patients was 23 (82 %), 21 (75 %) and 19 (68 %) at 5 min; 28 (100 %) at 10 and 20 min. Motor blockade of femoral nerve (FN) and obturator nerve (ON) was present in 13 (46 %) and 3 (11 %) patients at 5 min, 24 (86 %) and 9 (32 %) at 10 min, 26 (93 %) and 11 (39 %) at 20 min. Injectate permeated to the FN and extended superiorly over the surface of iliac muscle (IM) and pectineus muscle (PM) in all patients. Conclusions The modified S-FICB has provided an effective postoperative analgesic adjunct after THA with the satisfactory blockade of femoral (FN), obturator (ON) and sciatic (SN) nerves, especially for ON, when compared with the existing techniques.
Collapse
Affiliation(s)
- Ting Zheng
- The Provincial Clinical Medical College, Fujian Medical University, 134 Dong Street, Fujian, 350004, Fuzhou, China.,Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Bin Hu
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Chun-Ying Zheng
- The Provincial Clinical Medical College, Fujian Medical University, 134 Dong Street, Fujian, 350004, Fuzhou, China.,Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Feng-Yi Huang
- The Provincial Clinical Medical College, Fujian Medical University, 134 Dong Street, Fujian, 350004, Fuzhou, China.,Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Fei Gao
- The Provincial Clinical Medical College, Fujian Medical University, 134 Dong Street, Fujian, 350004, Fuzhou, China.,Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Xiao-Chun Zheng
- The Provincial Clinical Medical College, Fujian Medical University, 134 Dong Street, Fujian, 350004, Fuzhou, China. .,Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, Fujian, China. .,Fujian Provincial Emergency Center, Fuzhou, Fujian, China.
| |
Collapse
|
34
|
Fujino T, Odo M, Okada H, Takahashi S, Kikuchi T. Continuous pericapsular nerve group block for postoperative pain management in total hip arthroplasty: report of two cases. JA Clin Rep 2021; 7:22. [PMID: 33677707 PMCID: PMC7937578 DOI: 10.1186/s40981-021-00423-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the surgical procedures associated with severe postoperative pain. Appropriate postoperative pain management is effective for promoting early ambulation and reducing the length of hospital stay. Effects of conventional pain management strategies, such as femoral nerve block and fascia iliaca block, are inadequate in some cases. CASE PRESENTATION THA was planned for 2 patients with osteoarthritis. In addition to general anesthesia, continuous pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block were performed for postoperative pain management. Numerical rating scale (NRS) scores measured at rest and upon movement were low at 2, 12, 24, and 48 h postoperatively, suggesting that the treatments were effective for managing postoperative pain. The Bromage score at postoperative days (POD) 1 and 2 was 0. CONCLUSION Continuous PENG block and LFCN block were effective for postoperative pain management in patients who underwent THA. PENG block did not cause postoperative motor blockade.
Collapse
Affiliation(s)
- Takashi Fujino
- Department of Anesthesiology and Pain Medicine, Juntendo Nerima University Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
| | - Masahiko Odo
- Department of Anesthesiology and Pain Medicine, Juntendo Nerima University Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Hisako Okada
- Department of Anesthesiology and Pain Medicine, Juntendo Nerima University Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Shinji Takahashi
- Department of Anesthesiology and Pain Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Toshihiro Kikuchi
- Department of Anesthesiology and Pain Medicine, Juntendo Nerima University Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| |
Collapse
|
35
|
Pahwa D, Arora D, Das S. PENG block catheter for preoperative pain relief in a patient with fracture neck of femur. J Anaesthesiol Clin Pharmacol 2021; 37:664-665. [PMID: 35340976 PMCID: PMC8944376 DOI: 10.4103/joacp.joacp_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
|
36
|
Celi J, Fehlmann CA, Rutschmann OT, Pelieu-Lamps I, Fournier R, Nendaz M, Sarasin F, Rouyer F. Learning process of ultrasound-guided Ilio-fascial compartment block on a simulator: a feasibility study. Int J Emerg Med 2020; 13:57. [PMID: 33256593 PMCID: PMC7706061 DOI: 10.1186/s12245-020-00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/16/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ultrasound-guided fascia iliaca compartment block (US-FICB) is not part of the learning curriculum of the emergency physicians (EP) and is usually performed by anesthesiologists. However, several studies promote EP to use this procedure. The goal of this study was to assess the feasibility of a training concept for non-anesthesiologists for the US-FICB on a simulator based on a validating learning path. METHOD This was a feasibility study. Emergency physicians and medical students received a 1-day training with a learning phase (theoretical and practical skills), followed by an assessment phase. The primary outcome at the assessment phase was the number of attempts before successfully completing the procedure. The secondary outcomes were the success rate at first attempt, the length of procedure (LOP), and the stability of the probe, corresponding to the visualization of the needle tip (and its tracking) throughout the procedure, evaluated on a Likert scale. RESULTS A total of 25 participants were included. The median number of attempts was 2.0 for emergency physicians and 2.5 for medical students, and this difference was not significant (p = 0.140). Seven participants (28%) succeeded at the first attempt of the procedure; the difference between emergency physicians and medical students was not significant (37% versus 21%; p = 0.409). The average LOP was 19.7 min with a significant difference between emergency physicians and medical students (p = 0.001). There was no significant difference regarding the stability of the probe between the two groups. CONCLUSION Our 1-day training for non-anesthesiologists with or without previous skills in ultrasound seems to be feasible for learning the US-FICB procedure on a simulator.
Collapse
Affiliation(s)
- Julien Celi
- Emergency Unit, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 2, CH-1205, Geneva, Switzerland.
| | - Christophe A Fehlmann
- Emergency Unit, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 2, CH-1205, Geneva, Switzerland
| | - Olivier T Rutschmann
- Emergency Unit, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 2, CH-1205, Geneva, Switzerland
| | - Iris Pelieu-Lamps
- Anesthesiology Unit, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roxane Fournier
- Anesthesiology Unit, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, and Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Sarasin
- Emergency Unit, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 2, CH-1205, Geneva, Switzerland
| | - Frédéric Rouyer
- Emergency Unit, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 2, CH-1205, Geneva, Switzerland
| |
Collapse
|
37
|
Liang Y, Lv L, He L, Deng W, Chen C, Li J. A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia. Clin Interv Aging 2020; 15:1113-1119. [PMID: 32764898 PMCID: PMC7360407 DOI: 10.2147/cia.s251025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population. Patients and Methods Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented. Results The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning. Conclusion FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.
Collapse
Affiliation(s)
- Yi Liang
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Lv Lv
- Emergency Department, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Liang He
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Wei Deng
- Department of Anesthesiology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing, People's Republic of China
| | - Cai Chen
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Jingjuan Li
- Department of Anesthesiology, The Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| |
Collapse
|
38
|
Mysore K, Sancheti SA, Howells SR, Ballah EE, Sutton JL, Uppal V. Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study. Can J Anaesth 2020; 67:1673-1674. [DOI: 10.1007/s12630-020-01751-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/12/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
|
39
|
Implementation of the Obturator Nerve Block into a Supra-Inguinal Fascia Iliaca Compartment Block Based Analgesia Protocol for Hip Arthroscopy: Retrospective Pre-Post Study. ACTA ACUST UNITED AC 2020; 56:medicina56040150. [PMID: 32230895 PMCID: PMC7230392 DOI: 10.3390/medicina56040150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0–890.0) µg; FO: 482.8 (305.8–635.0) µg; p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8–803.0) µg). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.
Collapse
|
40
|
Prado-Kittel C, Zumelzu-Sánchez P, Palma-Licandeo A, Faúndez-Lillo G, Ellenberg-Oyarce K, Jorquera-Adarme B. Continuous pericapsular nerve group blockade as analgesia for fracture of the posterior column and wall of the acetabulum; a case report and description of infusion regimen for extending analgesic effect to the distal femoral area. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:159-162. [PMID: 32098698 DOI: 10.1016/j.redar.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/30/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
The use of peripheral nerve blockade for hip surgeries has proved to be beneficial. The PEricapsular Nerve Group block is a new technique described for hip fracture and hip arthroplasty that has shown to provide better analgesia compared to other peripheral blocks commonly performed for this type of surgery. This technique blocks the obturator nerve and the articular branches of the femoral nerve and the accessory obturator nerve. There are few reports describing continuous analgesia using catheters inserted in the pericapsular nerve group area. We describe a case of continuous nerve block for preoperative analgesia that lasted up to 120hours in an adult patient with a fracture of the posterior column and wall of the acetabulum. We found that by increasing the infusion rate, analgesia reached the distal femoral area. Unlike the original technique, a high-frequency linear probe was used in this case.
Collapse
Affiliation(s)
- C Prado-Kittel
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile.
| | - P Zumelzu-Sánchez
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile
| | - A Palma-Licandeo
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile
| | - G Faúndez-Lillo
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile
| | - K Ellenberg-Oyarce
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile
| | - B Jorquera-Adarme
- Programa de formación de especialistas en Anestesiología y Reanimación, Universidad Austral de Chile, Valdivia, Chile; Subdepartamento de pabellones quirúrgicos, Hospital Base de Valdivia, Valdivia, Chile
| |
Collapse
|
41
|
Ahiskalioglu A, Aydin ME, Ahiskalioglu EO, Tuncer K, Celik M. Pericapsular nerve group (PENG) block for surgical anesthesia of medial thigh. J Clin Anesth 2020; 59:42-43. [DOI: 10.1016/j.jclinane.2019.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
|
42
|
Xu Z, Mei B, Liu M, Tu L, Zhang H, Zhang M. Fibrous configuration of the fascia iliaca compartment: An epoxy sheet plastination and confocal microscopy study. Sci Rep 2020; 10:1548. [PMID: 32005916 PMCID: PMC6994512 DOI: 10.1038/s41598-020-58519-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: The underlying anatomical mechanism of the ultrasound-guided fascia iliaca compartment (FIC) block for anaesthesia and analgesia in the lower limb has not been illuminated and numerous variations were attempted to achieve an optimal needle placement. This study aimed to define the fibrous configuration of the FIC. Methods: A total of 46 adult cadavers were studied using dissection, latex injection, epoxy sheet plastination and confocal microscopy. Results: (1) The fascia iliaca originated from the peripheral fascicular aponeurotic sheet of the iliopsoas. (2) The FIC was a funnel-shaped adipose space between the fascia iliaca and the epimysium of the iliopsoas, had a superior and an inferior opening and contained the femoral and lateral femoral cutaneous nerves but not obturator nerve. (3) The estimated volume of the FIC in the cadavers was about 23 mls, of which about one third was below the level of the anterior superior iliac spine. Conclusions: This study revealed that the fascia iliaca was aponeurotic and may be less permeable for the local anesthetics. Conclusions: The FIC contained only the femoral and lateral femoral cutaneous nerves and communicated with the extraperitoneal space and femoral triangle adipose space via its superior and inferior opening, respectively.
Collapse
Affiliation(s)
- Zhaoyang Xu
- Department of Anatomy, Anhui Medical University, Hefei, China.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Bin Mei
- Department of Anaesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming Liu
- Department of Ultrasound, Taian Chinese Traditional Medicine Hospital, Taian, China
| | - Lili Tu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Han Zhang
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
| |
Collapse
|
43
|
Electromyographic Comparison of the Efficacy of Ultrasound-guided Suprainguinal and Infrainguinal Fascia Iliaca Compartment Block for Blockade of the Obturator Nerve in Total Knee Arthroplasty. Clin J Pain 2019; 36:260-266. [DOI: 10.1097/ajp.0000000000000795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
44
|
Jiang M, Yan G, Deng H, Liang H, Lin Y, Zhang X. The efficacy of regular penis-root masturbation, versus Kegel exercise in the treatment of primary premature ejaculation: A quasi-randomised controlled trial. Andrologia 2019; 52:e13473. [PMID: 31746051 DOI: 10.1111/and.13473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 01/23/2023] Open
Abstract
To explore the efficacy of regular penis-root masturbation (PRM) versus Kegel exercise (KE) in the treatment of primary premature ejaculation (PPE). This study was a prospective quasi-randomised controlled trial. Thirty-seven heterosexual males with PPE were selected according to the time sequence of outpatient consultations and the preliminary results of a pre-experiment and were assigned to an PRM group and a KE group. Differences in intravaginal ejaculatory latency times (IELTs) and premature ejaculation diagnostic tool (PEDT) scores were compared between the two groups. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Among the 37 PPE patients, 18 performed PRM and 19 patients performed KE. The IELTs of patients who performed PRM and KE were significantly prolonged before treatment, and the difference after treatment was statistically significant (p < .05). Compared with the KE group, the IELT prolongation effect in the PRM group was more significant PRM (p < .05). The PEDT scores of patients after performing PRM and KE were significantly lower than those before performing these exercises (p < .05). Compared with the KE group, the PEDT scores of the PRM group exhibited a greater decrease (p < .05). Thus, both PRM and KE have therapeutic effects on PPE. Compared with KE, PRM is more effective in the treatment of PPE.
Collapse
Affiliation(s)
- Mingyang Jiang
- Department of Andrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | | | - Hao Liang
- Guangxi Medical University, Nanning, China
| | - Yunni Lin
- Guangxi Medical University, Nanning, China
| | - Xun Zhang
- Department of Andrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
45
|
Zhou Y, Zhang WC, Chong H, Xi Y, Zheng SQ, Wang G, Wu XB. A Prospective Study to Compare Analgesia from Femoral Obturator Nerve Block with Fascia Iliaca Compartment Block for Acute Preoperative Pain in Elderly Patients with Hip Fracture. Med Sci Monit 2019; 25:8562-8570. [PMID: 31721757 PMCID: PMC6873637 DOI: 10.12659/msm.915289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to compare femoral obturator nerve block (FONB) with fascia iliaca compartment block (FICB) in the management of acute preoperative pain in elderly patients with hip fracture. Material/Methods Patients ≥65 years (n=154) diagnosed with hip fracture who had surgery within 48 hours of hospital admission included two groups who received ultrasound-guided nerve block, the FONB group (n=77), and the FICB group (n=77). The visual analog scale (VAS) score for pain, requirement for analgesic drugs, nursing care requirements after hospitalization, post-operative complications, and rehabilitation were compared between the FONB and FICB patient groups. Results The VAS scores after both nerve block procedures were significantly reduced compared with those before both nerve block procedures (P<0.05), but there were no differences on the second day after nerve block. The VAS scores at rest and on exercise in the FONB group were significantly lower than those in the FICB group at 30 min and one day after nerve block (P<0.05). The requirement for postoperative analgesic drugs in the FONB group was significantly lower than that in the FICB group (P=0.048). The incidence of nausea and vertigo in the FICB group were significantly higher than in the FONB group (P=0.031 and P=0.034, respectively). Patients in the FONB group experienced significantly improved quality of postoperative function (P=0.029). Conclusions Both FONB and FICB provided pain control for elderly patients with hip fracture. However, compared with FICB, FONB resulted in significantly improved analgesia with a reduced requirement for analgesic drugs.
Collapse
Affiliation(s)
- Yan Zhou
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Wen-Chao Zhang
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Hao Chong
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Yang Xi
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Shao-Qiang Zheng
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Geng Wang
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| | - Xin-Bao Wu
- Beijing Jishuitan Hospital, The 4th Clinical Medical College of Peking University, Beijing, China (mainland)
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving specific orthopaedic surgical procedures. RECENT FINDINGS Recent emerging interest in hip and knee denervation for chronic pain management secondary to osteoarthritis stimulates publications on the new understanding of hip and knee joint innervation. The improved understanding of the anatomy allows better precision in targeting the articular branches. The procedures for chronic joint pain such as radiofrequency ablation, chemical neurolysis and neuromodulation procedure have recently been applied to the perioperative care in orthopaedic procedures because of the potential long-lasting analgesia, opioid-sparing effect and consequent improvement in physical function and health-related quality of life after surgery. SUMMARY Despite the widespread use of regional anaesthesia and multimodal analgesia in the perioperative pain management, more than two-third of the patients reported severe postoperative pain. Therefore, other therapeutic strategies used in chronic pain management such as radiofrequency ablation and neuromodulation have been proposed to optimize acute postsurgical pain. The early experience with those techniques is encouraging, and more studies are required to explore the incorporation of these procedures in the perioperative care.
Collapse
|
47
|
|
48
|
Fascia iliaca compartment blocks: Different techniques and review of the literature. Best Pract Res Clin Anaesthesiol 2019; 33:57-66. [DOI: 10.1016/j.bpa.2019.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022]
|
49
|
Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med 2018; 43:859-863. [PMID: 30063657 DOI: 10.1097/aap.0000000000000847] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fascia iliaca block or femoral nerve block is used frequently in hip fracture patients because of their opioid-sparing effects and reduction in opioid-related adverse effects. A recent anatomical study on hip innervation led to the identification of relevant landmarks to target the hip articular branches of femoral nerve and accessory obturator nerve. Using this information, we developed a novel ultrasound-guided approach for blockade of these articular branches to the hip, the PENG (PEricapsular Nerve Group) block. In this report, we describe the technique and its application in 5 consecutive patients.
Collapse
|
50
|
Büttner B, Dracklé J, Kristof K, Hinz J, Schwarz A, Bauer M, Mansur A, Bergmann I. Paths of femoral nerve catheters placed using ultrasound-guided in plane vs out of plane techniques: A randomized controlled clinical trial. Medicine (Baltimore) 2018; 97:e12958. [PMID: 30412115 PMCID: PMC6221616 DOI: 10.1097/md.0000000000012958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Continuous blockade of the femoral nerve is widely used for postoperative analgesia after hip surgery. It can be achieved by ultrasound-guided placement of a femoral nerve catheter via either the in plane (IP) or out of plane (OOP) technique. On the basis of postoperative radiographs, we evaluated the paths of femoral nerve catheters with respect to both techniques and its effect on postoperative analgesia. METHODS Thirty-four patients were randomized to receive a radiopaque femoral nerve catheter via either the IP or OOP technique. The paths and tip position of the catheters were evaluated in postoperative frontal radiographs of the operated hip joint concerning a predefined target region and four neighboring regions. Pain scores were assessed using a numeric rating scale (0-10). RESULTS Sixteen IP patients and 18 OOP patients were included in the study. The catheter path was radiographically evaluated in 13 IP patients and in 10 OOP patients. The catheter tips were located within the target region in 39% of the IP group and in 50% of the OOP group. The catheter tip was 0.00 cm [-3.80 to 3.84] and -1.19 cm [-12.27 to 0.00] (median [range]) from the target region in the OOP group and IP group, respectively (P = .045). Catheters flipped distally more often in the IP group (IP: 61.5%, OOP: 10.0%; P = .01). There were no marked differences in the pain scores of either group. CONCLUSION Femoral nerve catheters inserted by the ultrasound-guided IP technique flip distally more frequently than catheters inserted by the OOP technique. Moreover, the distance between the catheter tip and the trunk of the femoral nerve is greater for IP catheters than for OOP catheters. Despite these findings, postoperative analgesia did not seem to differ between the 2 techniques.
Collapse
Affiliation(s)
- Benedikt Büttner
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Joschka Dracklé
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Katalin Kristof
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - José Hinz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Klinikum Region Hannover, Hannover
| | - Alexander Schwarz
- Department of Neuroradiology, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - Martin Bauer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Klinikum Region Hannover, Hannover
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Ingo Bergmann
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| |
Collapse
|