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Küçük O, Sağ F, Eyrice A, Karadayı S, Alagöz A, Çolak A. Comparison of the Analgesic Effect of Pericapsular Nerve Group Block and Lumbar Erector Spinae Plane Block in Elective Hip Surgery. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:799. [PMID: 38792981 PMCID: PMC11123060 DOI: 10.3390/medicina60050799] [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: 04/23/2024] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The aim of this study was to compare the effectiveness of pericapsular nerve group (PENG) and lumbar erector spinae plane (L-ESP) blocks, both administered with a high volume (40 mL) of local anesthetic (LA), for multimodal postoperative analgesia in patients undergoing hip surgery. Materials and Methods: This was a prospective, double-blind, randomized study that included 75 adult patients who were divided into three equal groups: control, PENG, and L-ESP. The study compared pain intensity, morphine consumption, time to first morphine request, and postoperative satisfaction between the control group, which received standard multimodal analgesia, and the block groups, which received PENG or L-ESP block in addition to multimodal analgesia. The numerical rating scale (NRS) was used to measure pain intensity. Results: The results showed that the block groups had lower pain intensity scores and morphine consumption, a longer time to the first morphine request, and higher postoperative satisfaction compared to the control group. The median maximum NRS score during the first 12 h was four in the control group, two in the PENG group, and three in the L-ESP group. The control group (21.52 ± 9.63 mg) consumed more morphine than the two block groups (PENG, 11.20 ± 7.55 mg; L-ESP, 12.88 ± 8.87 mg) and requested morphine 6.8 h earlier and 5 h earlier than the PENG and L-ESP groups, respectively. The control group (median 3) had the lowest Likert satisfaction scores, while the PENG group (median 4) had the lowest NRS scores (L-ESP, median 4). Conclusions: The application of PENG or L-ESP blocks with high-volume LA in patients undergoing hip surgery reduces the need for postoperative analgesia and improves the quality of multimodal analgesia.
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Affiliation(s)
- Onur Küçük
- Department of Anesthesiology and Reanimation, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (O.K.); (A.A.)
| | - Fatih Sağ
- Clinic of Anesthesiology and Reanimation, Tavşanlı Associate Professor Doctor Mustafa Kalemli State Hospital, 43300 Kütahya, Turkey;
| | - Ali Eyrice
- Department of Anesthesiology and Reanimation, Trakya University Medical Faculty, 22030 Edirne, Turkey;
| | - Selman Karadayı
- Department of Anesthesiology and Reanimation, Kırklareli University Medical Faculty, 39100 Kırklareli, Turkey;
| | - Ali Alagöz
- Department of Anesthesiology and Reanimation, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (O.K.); (A.A.)
| | - Alkin Çolak
- Department of Anesthesiology and Reanimation, Trakya University Medical Faculty, 22030 Edirne, Turkey;
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Liu M, Gao M, Hu Y, Ren X, Li Y, Gao F, Dong J, Dong J, Wang Q. Comparison of the Effect of Pericapsular Nerve Group Block Combined with Lateral Femoral Cutaneous Nerve Block and Fascia Iliaca Compartment Block in Patients Undergoing Hip Arthroscopy Under General Anesthesia: A Randomized, Double-Blind Trial. J Pain Res 2024; 17:1651-1661. [PMID: 38736679 PMCID: PMC11086438 DOI: 10.2147/jpr.s456880] [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: 01/03/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Patients undergoing arthroscopic hip surgery (AHS) require good analgesia and early rehabilitation after surgery, and there is no consensus on the optimal nerve block. We aimed to compare the efficacy of the pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve (LFCN) block compared to fascia iliaca compartment block (FICB) in patients with AHS. Patients and Methods A total of 80 patients receiving AHS under general anesthesia were randomized to receive either FICB (group F) or PENG block in combination with LFCN block (group P). The primary outcomes were the rate of quadriceps weakness after block on the afflicted side, as well as muscle strength grading and pain score after block, and the quality of recovery on the second postoperative day. Results Compared with group F, group P had a lower incidence of quadriceps weakness 48 h after block (76.9% vs 28.2%, P < 0.001), and had less impact on muscle strength grade and lower static pain score at 6, 12, 18, 24, 36, and 48 h after block (P < 0.001), and a lower dynamic pain score at 6 and 12 h after block in group P (p < 0.05). The quality of recovery on the second postoperative day improved (p < 0.05). Conclusion In comparison to FICB, PENG block in combination with LFCN block can affect less quadriceps muscle strength and reduce the use of postoperative analgesics, which is beneficial for the postoperative recovery of AHS patients.
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Affiliation(s)
- Menglin Liu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Mingyang Gao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Yufei Hu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Xiaoqin Ren
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Yanan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Fang Gao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Jianglong Dong
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Jiangtao Dong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Qiujun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China
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Pascarella G, Costa F, Strumia A, Ruggiero A, Remore LM, Lanteri T, Hazboun A, Longo F, Gargano F, Schiavoni L, Mattei A, Agrò FE, Carassiti M, Cataldo R. Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial. J Clin Med 2024; 13:2674. [PMID: 38731203 PMCID: PMC11084625 DOI: 10.3390/jcm13092674] [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: 03/26/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.
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Affiliation(s)
- Giuseppe Pascarella
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Fabio Costa
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Strumia
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Ruggiero
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Luigi Maria Remore
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Tullio Lanteri
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Anton Hazboun
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Ferdinando Longo
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Francesca Gargano
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Lorenzo Schiavoni
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessia Mattei
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Felice Eugenio Agrò
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Rita Cataldo
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
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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.
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Affiliation(s)
- Poonam Pai
- Icahn School Of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside Hospitals, NY
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Fontes GM, Perez MV, Miashiro EH, Neto AIDS, Grigio TR, Rodrigues LHS. Pericapsular Hip Block Guided by Ultrasonography in Elderly People with Hip Fracture in the Emergency Sector: Clinical Trial. Rev Bras Ortop 2024; 59:e284-e296. [PMID: 38606128 PMCID: PMC11007597 DOI: 10.1055/s-0044-1785494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 04/13/2024] Open
Abstract
Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients ( p < 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group ( p < 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group.
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Affiliation(s)
- Gustavo Martins Fontes
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Dr. Alípio Corrêa Netto (HMACN), São Paulo, SP, Brasil
- Serviço de Terapia da Dor, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Vaz Perez
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Edson Hidenori Miashiro
- Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina, Fundação Educacional do Município de Assis (FEMA), Assis, SP, Brasil
| | - Antonio Isidoro de Sousa Neto
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Dr. Alípio Corrêa Netto (HMACN), São Paulo, SP, Brasil
| | - Thiago Ramos Grigio
- Grupo de Dor, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brasil
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Li S, An J, Qian C, Wang Z. Efficacy and Safety of Pericapsular Nerve Group Block for Hip Fracture Surgery under Spinal Anesthesia: A Meta-Analysis. Int J Clin Pract 2024; 2024:6896066. [PMID: 38510561 PMCID: PMC10954362 DOI: 10.1155/2024/6896066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/28/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Objective To evaluate the effectiveness and safety of pericapsular nerve group (PENG) block for hip fracture surgery under spinal anesthesia. Methods This meta-analysis was registered on INPLASY (INPLASY202270005). PubMed, Embase, Cochrane, CNKI, and Wanfang databases were searched to collect the randomized controlled trials of the PENG block applied to hip fracture surgery in the setting of spinal anesthesia, with the search period from inception to 1 May 2023. Two independent researchers gradually screened the literature, evaluated the quality, extracted the data, and eventually pooled data using RevMan 5.4. Results Fifteen articles with 890 patients were enrolled. The combined results showed that the PENG block reduced pain scores during position placement (SMD = -0.35; 95% CI [-0.67, 0.02]; P=0.04; I2 = 0%). Subgroup analyses showed that compared to the unblocked group, the PENG block reduced pain scores at 12 h, 24 h, and 48 h postoperatively. The incidence of postoperative hypokinesia was reduced (RR = 0.11; 95% CI [0.01, 0.86]; P=0.04; I2 = 0.00%). The time to first walking was advanced (SMD = -0.90; 95% CI [-1.17, 0.63]; P < 0.00001; I2 = 0%). Conclusion The PENG block can reduce postoperative pain and pain during spinal anesthesia positioning, which is helpful to improve the operability and comfort of spinal anesthesia and facilitate postoperative muscle strength recovery and early activity.
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Affiliation(s)
- Shukai Li
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Jing An
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Chengyu Qian
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Zhixue Wang
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
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Christopher S, Dutta S, Gopal TVS. Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement. World J Anesthesiol 2024; 13:90514. [DOI: 10.5313/wja.v13.i1.90514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/05/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Osteonecrosis or avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients. Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous (IV) or oral dexamethasone, methylprednisolone or hydrocortisone. The use of such high doses of corticosteroids has shown very positive results and has been lifesaving in many cases. Still, long-term consequences were drug-induced diabetes, osteoporosis, Cushing syndrome, muscle wasting, peripheral fat mobilization, AVN, hirsutism, sleep disturbances and poor wound healing. A significant number of young patients were admitted for bilateral total hip replacements (THR) secondary to AVN following steroid use for COVID-19 treatment.
AIM To assess the efficacy of bilateral pericapsular end nerve group (PENG) blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.
METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals, Hyderabad, India. Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months. All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.
RESULTS The duration of surgery was 2.5 h on average. Seventeen out of twenty patients (85%) had a Visual Analog Score (VAS) of less than 2 and did not require any supplementation. One patient was removed from the study, as he required re-exploration. The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug. Fifteen out of seventeen patients (88.2%) could be mobilized 12 h after the procedure.
CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19, which surfaced in patients who received steroid therapy requiring surgical intervention. Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
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Affiliation(s)
| | - Sweety Dutta
- Department of Anaesthesiology, Care Hospitals, Hyderabad 500025, India
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Ke J, Yang Y, Cao Y, Wang Y, Lin C. Efficacy and safety of pericapsular nerve group block in total hip arthroplasty: a meta-analysis and systematic review. Minerva Anestesiol 2024; 90:200-209. [PMID: 37987992 DOI: 10.23736/s0375-9393.23.17618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Ensuring effective perioperative pain control is a crucial aspect of rehabilitation programs following total hip arthroplasty. This study presents a comprehensive meta-analysis and systematic review to assess the efficacy and safety of pericapsular nerve group block (PENG) in the context of total hip arthroplasty. EVIDENCE ACQUISITION A systematic search was conducted in multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science, to identify relevant randomized controlled studies investigating the efficacy and safety of PENG for total hip arthroplasty. The search was conducted up until 1st June 2023. Data analysis was performed using Stata v. 15.0. EVIDENCE SYNTHESIS A total of 721 individuals participated in this study, which included 13 randomized controlled trials. Among them, 377 individuals were assigned to the experimental group, while 344 individuals were assigned to the control group. The findings from the meta-analysis indicated that the application of PENG yielded favorable outcomes in terms of reducing six-hour pain scores (SMD=-0.63, 95% CI -1.18, -0.09) and 24-hour pain scores (SMD=-1.45, 95% CI -2.51, -0.29). Moreover, it was found to decrease opioid consumption (SMD=-0.84, 95% CI -1.35, -0.34), without causing a significant increase in nausea and vomiting (RR=0.75, 95% CI 0.45, 1.23) or urinary retention (RR=2.46, 95% CI 0.49, 12.31). CONCLUSIONS Based on the latest findings, PENG has been shown to effectively decrease pain scores within six and 24 hours following total hip arthroplasty. However, its effectiveness in pain control diminishes after 48 hours. Additionally, PENG has demonstrated the ability to reduce opioid consumption without an accompanying increase in adverse drug events.
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Affiliation(s)
- Jinyong Ke
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Cao
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuyan Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Chunshui Lin
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China -
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Eppel B, Schneider MM, Gebhardt S, Balcarek P, Sobau C, Wawer Matos J, Zimmerer A. Pericapsular Nerve Group Block Leads to Small but Consistent Reductions in Pain Between 18 and 24 Hours Postoperatively in Hip Arthroscopy for Femoroacetabular Impingement Surgery: A Prospective, Randomized Controlled Clinical Trial. Arthroscopy 2024; 40:373-380. [PMID: 37355181 DOI: 10.1016/j.arthro.2023.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To investigate whether the use of a pericapsular nerve group (PENG) block would reduce perioperative pain after arthroscopic therapy for femoroacetabular impingement syndrome (FAIS) and to examine opioid requirements and occurrence of postoperative nausea and vomiting (PONV). METHODS Between May 2022 and October 2022, patients (N = 68) undergoing arthroscopic surgery for FAIS were randomly allocated into 2 groups. The first group received an ultrasound-guided PENG preoperatively with 20 mL of 0.375% ropivacaine and standardized postoperative oral medication. The second group received a sham block preoperatively with 20 mL of 0.9% saline and standardized postoperative oral medication. The primary end point was pain scores (visual analog score [VAS], 0-10) during the first 24 hours postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the minimal clinically important difference (MCID) was calculated using the half standard deviation method. The incidence of PONV as well as opioid usage (converted to morphine equivalent) within the first 24 hours were secondary outcomes. RESULTS Randomization and permission were successfully obtained from 68 participants. From the fifteenth postoperative hour, the PENG group reported significantly less postoperative pain than the control group (24th postoperative hour: VAS pain PENG group 1.3 ± 0.9 [0-3]; 95% confidence interval {CI} 0.4-1.2 vs the VAS pain control group 2.4 ± 1.6 [0-5]; 95% CI 1.4-4.7; P = .009). The VAS pain score threshold for achieving the MCID at 24 hours postoperative was defined as a decrease of 1.1. 27 patients (79%) in the PENG group and 22 patients (65%) in the control group were able to achieve MCID (P = .009). Opioid dosage and postoperative nausea did not differ significantly between groups (P = .987 and P = .655, respectively). Concomitant complications such as falls, hematomas, or weakened muscles did not occur in either group. CONCLUSIONS According to this study, a PENG block minimally reduced pain after arthroscopic treatment for FAIS between the 18th and 24th postoperative hours. The PENG group achieved significantly more often the pain VAS MCID. However, there was no proof that the PENG group consumed fewer opioids than the control group. Overall, PONV was found at a low and comparable rate. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
| | - Marco M Schneider
- MVZ Praxisklinik Orthopädie Aachen, University of Aachen, Aachen, Germany; University Witten/Herdecke, Witten, Germany
| | - Sebastian Gebhardt
- Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany
| | | | | | | | - Alexander Zimmerer
- ARCUS Sportklinik, Pforzheim, Germany; Department of Orthopaedics, University Medicine Greifswald, Greifswald, Germany; Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Germany.
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10
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Braun AS, Peabody Lever JE, Kalagara H, Piennette PD, Arumugam S, Mabry S, Thurston K, Naranje S, Feinstein J, Kukreja P. Comparison of Pericapsular Nerve Group (PENG) Block Versus Quadratus Lumborum (QL) Block for Analgesia After Primary Total Hip Arthroplasty Under Spinal Anesthesia: A Retrospective Study. Cureus 2023; 15:e50119. [PMID: 38192933 PMCID: PMC10771930 DOI: 10.7759/cureus.50119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most common operative procedures performed. Controlling postoperative pain following THA remains a challenge due to the complex innervation of the hip joint and the recent desire to preserve motor function following nerve blockade. Several nerve block techniques have been used for THA in the past, but the quadratus lumborum (QL) block and the blockade of the pericapsular nerve group (PENG) have emerged as opiate-sparing regional anesthesia techniques that preserve motor function. To date, little data comparing the two block techniques exists. The purpose of our study was to compare outcomes following these techniques in patients undergoing primary THA. MATERIALS AND METHODS This retrospective analysis utilized data from three distinct groups who underwent primary THA at our institution: 45 patients who received PENG block, 38 patients who received QL block, and 77 control patients. Chart review analysis was performed by authorized personnel to obtain cumulative oral morphine equivalent (OME) data at 24 and 48 hours postoperatively (primary outcomes). In addition, visual analog pain scale (VAS) scores in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours, ambulation distance, and length of hospital stay data were obtained (secondary outcomes). Group comparisons were conducted using either analysis of variance (ANOVA) with Tukey's multiple comparison test for parametric data or Krustal-Wallis with Dunn's multiple comparison tests for nonparametric endpoints. RESULTS This study found a statistically significant difference in cumulative OME usage across all groups at 24 and 48 hours. Significant difference in OMEs was found between QL and control and PENG and control; however, no difference was found in OMEs between PENG and QL groups at either time point. There was a statistically significant difference in VAS scores in the PACU across all groups; QL showed significantly lower VAS scores in the PACU compared to PENG and control, while PENG only showed significantly lower VAS scores compared to control. There was a statistically significant difference in VAS scores at 24 hours across all groups; however, only QL showed significantly lower VAS scores compared to control at 24 hours. QL was associated with a statistically significant increase in the length of hospital stay compared to PENG. CONCLUSION This study showed no difference between OME usage in patients who received PENG or QL nerve blocks for primary THA. VAS scores were similar between groups with the exception of QL outperforming PENG in the PACU. Optimizing postoperative pain via multi-approach strategies should remain a priority for patients undergoing THA. Future research is warranted in order to provide guidance on best practice for these patients.
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Affiliation(s)
- Andrew S Braun
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Jacelyn E Peabody Lever
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
- Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
| | - Paul D Piennette
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Sivasenthil Arumugam
- Anesthesiology, University of Connecticut School of Medicine, Farmington, USA
- Anesthesiology, Saint Francis Hospital and Medical Center / University of Connecticut, Hartford, USA
| | - Scott Mabry
- Orthopaedics, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Kesha Thurston
- Anesthesiology, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Sameer Naranje
- Orthopaedics, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Joel Feinstein
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB), Birmingham, USA
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11
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Restrepo-Holguin M, Kopp SL, Johnson RL. Motor-sparing peripheral nerve blocks for hip and knee surgery. Curr Opin Anaesthesiol 2023; 36:541-546. [PMID: 37552001 DOI: 10.1097/aco.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. RECENT FINDINGS Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation. SUMMARY The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.
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12
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Bravo D, Aliste J, Layera S, Fernández D, Erpel H, Aguilera G, Arancibia H, Barrientos C, Wulf R, León S, Brañes J, Finlayson RJ, Tran DQ. Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty. Reg Anesth Pain Med 2023; 48:489-494. [PMID: 36797036 DOI: 10.1136/rapm-2023-104332] [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: 01/11/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). METHODS Sixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay. RESULTS There were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours). CONCLUSION For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER NCT05087862.
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Affiliation(s)
- Daniela Bravo
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Julián Aliste
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Sebastián Layera
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Diego Fernández
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Hans Erpel
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Germán Aguilera
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | - Hernán Arancibia
- Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
| | | | - Rodrigo Wulf
- Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
| | - Sebastián León
- Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
| | - Julián Brañes
- Orthopedic Surgery, University of Chile, Santiago de Chile, Chile
| | - Roderick J Finlayson
- Pain and Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - De Q Tran
- Anesthesiology, McGill University, Montreal, Québec, Canada
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13
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Hou HJ, Li XT, Xue FS. Comments on "Ultrasound-guided adductor canal block is superior to femoral nerve block for early postoperative pain relief after single-bundle anterior cruciate ligament reconstruction with hamstring autograft". J Med Ultrason (2001) 2023; 50:581-582. [PMID: 37402023 DOI: 10.1007/s10396-023-01337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Hai-Jun Hou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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14
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Nijs K, Ruette J, Van de Velde M, Stessel B. Regional anaesthesia for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:397-408. [PMID: 37938085 DOI: 10.1016/j.bpa.2022.12.001] [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: 10/25/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Regional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19.
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Affiliation(s)
- Kristof Nijs
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; KULeuven, Department of Cardiovascular Sciences, Leuven, Belgium; Department of Anaesthesiology and Pain Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Joke Ruette
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium; Department of Anaesthesiology and Pain Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Van de Velde
- KULeuven, Department of Cardiovascular Sciences, Leuven, Belgium; Department of Anaesthesiology and Pain Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Björn Stessel
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
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15
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Baratta JL, Deiling B, Hassan YR, Schwenk ES. Total joint replacement in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:269-284. [PMID: 37929822 DOI: 10.1016/j.bpa.2023.03.005] [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: 11/14/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Total joint arthroplasty is one of the most commonly performed surgical procedures in the United States, and projected numbers are expected to double in the next ten years. From 2018 to 2020, total hip and knee arthroplasty were removed from the United States' Center for Medicare and Medicaid Services "inpatient-only" list, accelerating this migration to the ambulatory setting. Appropriate patient selection, including age, body mass index, comorbidities, and adequate social support, is critical for successful ambulatory total joint arthroplasty. General anesthesia and neuraxial anesthesia are both safe and effective anesthetic choices, and recent studies in this population have found no difference in outcomes. Multimodal analgesia, including acetaminophen, nonsteroidal anti-inflammatory drugs, local infiltration analgesia, and peripheral nerve blocks, is the foundation for adequate pain control. Common reasons for "failure to launch" include postoperative urinary retention, postoperative nausea and vomiting, inadequate analgesia, and hypotension.
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Affiliation(s)
- Jaime L Baratta
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, Suite 8290, Philadelphia, PA 19107, USA.
| | - Brittany Deiling
- Department of Anesthesiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA.
| | - Yasser R Hassan
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, Suite 8290, Philadelphia, PA 19107, USA.
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, Gibbon Building, Suite 8290, Philadelphia, PA 19107, USA.
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16
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Kukreja P, Uppal V, Kofskey AM, Feinstein J, Northern T, Davis C, Morgan CJ, Kalagara H. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. Br J Anaesth 2023; 130:773-779. [PMID: 36964012 DOI: 10.1016/j.bja.2023.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that has been proposed as an effective motor-sparing block for total hip arthroplasty. Recent randomised studies show conflicting results regarding the analgesic efficacy of the PENG block for total hip arthroplasty. METHODS We conducted a randomised controlled observer-blinded single-centre superiority trial comparing the efficacy of the PENG block with no block for patients undergoing primary total hip arthroplasty under spinal anaesthesia. All subjects received multimodal analgesia consisting of paracetamol and celecoxib. The primary outcome was quality of recovery (QoR) at 24 h as measured by the QoR-15 questionnaire. RESULTS A total of 112 participants (56 in each group) were included in the analysis. The median (inter-quartile range [IQR]) 24-h QoR-15 scores were higher in subjects who received a PENG block (132 [116-138]) compared with subjects who did not (103 [97-112]) with a median difference of 26 (95% confidence interval, 18-31; P<0.001). Similarly, QoR-15 at 48 h was higher in the PENG group, and opioid use at 24 and 48 h postoperatively was significantly lower in the PENG group. However, we did not find significant differences in pain score, distance to ambulation, or anti-emetic use at any time point. We did not observe any PENG block-related complications. CONCLUSION Adding a PENG block to a multimodal analgesia regimen that includes paracetamol and celecoxib improves the quality of recovery and reduces opioid requirements for patients undergoing primary total hip arthroplasty under spinal anaesthesia. CLINICAL TRIAL REGISTRATION NCT04591353.
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Affiliation(s)
- Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada.
| | - Alexander M Kofskey
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joel Feinstein
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Theresa Northern
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Camille Davis
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
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17
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Hewson DW, Scott CEH, Macfarlane AJR. Regional analgesia for total hip arthroplasty and Schwartz's paradox. Br J Anaesth 2023; 130:650-654. [PMID: 37105898 DOI: 10.1016/j.bja.2023.03.023] [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: 03/10/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Enhanced recovery after total hip arthroplasty aims to facilitate return to function and early hospital discharge, but the role of novel fascial plane block techniques in such pathways is uncertain. A randomised trial by Kukreja and colleagues describes superior quality of recovery after hip arthroplasty in patients receiving a pericapsular nerve group (PENG) block. We discuss the trial findings in the context of ongoing uncertainty regarding best analgesic practice for this surgical procedure.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care Medicine, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Anaesthesia, Queen's Medicine Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK; Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Alan J R Macfarlane
- Department of Anaesthetics, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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18
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Liang L, Zhang C, Dai W, He K. Comparison between pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve block and supra-inguinal fascia iliaca compartment block (S-FICB) for total hip arthroplasty: a randomized controlled trial. J Anesth 2023:10.1007/s00540-023-03192-6. [PMID: 37043081 PMCID: PMC10390614 DOI: 10.1007/s00540-023-03192-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/04/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE To assess the efficacy of pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block in controlling postoperative pain and promoting recovery of lower extremity after total hip arthroplasty (THA), and to compare its effectiveness with supra-inguinal fascia iliaca compartment block (S-FICB). MATERIALS AND METHODS 92 patients undergoing THA with general anesthesia were randomly allocated to receive either a PENG with LFCN block (n = 46) using 30 ml 0.33% ropivacaine (20 ml for PENG block, 10 ml for LFCN block), or an S-FICB (n = 46) using 30 ml 0.33% ropivacaine. The primary outcome was the time to first postoperative walk. The secondary outcomes included intraoperative remifentanil consumption, postoperative hip flexion degree and muscle strength of the operative lower limbs in the supine position, pain scores (static and dynamic), rescue analgesia, postoperative nausea and vomiting (PONV), and nerve block-related complications. RESULTS The combination of PENG with LFCN blocks resulted in an earlier first postoperative walking time (19.6 ± 9.6 h vs 26.5 ± 8.2 h, P < 0.01), greater postoperative hip flexion degree at 6 h, 24 h and 48 h (all P < 0.01), and higher muscle strength of the operative lower limbs at 6 h after surgery (P = 0.03) compared to S-FICB. The difference in pain scores (static and dynamic) was only statistically significant at 48 h (P < 0.05). There were no differences in the other outcomes. CONCLUSIONS PENG with LFCN blocks is more effective than S-FICB in shortening the time to first postoperative walk and preservation hip motion after THA, which makes it a suitable addition to enhanced recovery programs following surgery.
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Affiliation(s)
- Ludan Liang
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, Chongqing, China
| | - Can Zhang
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Dai
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, Chongqing, China
| | - Kaihua He
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, Chongqing, China.
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19
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Ying H, Chen L, Yin D, Ye Y, Chen J. Efficacy of pericapsular nerve group block vs. fascia iliaca compartment block for Hip surgeries: A systematic review and meta-analysis. Front Surg 2023; 10:1054403. [PMID: 36843984 PMCID: PMC9953592 DOI: 10.3389/fsurg.2023.1054403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023] Open
Abstract
Objective The review aimed to compare outcomes of pericapsular nerve group block (PENG) vs. fascia iliaca compartment block (FICB) for patients undergoing hip surgeries. Methods Randomized controlled trials (RCTs) published in the databases of PubMed, CENTRAL, Embase, and Web of Science comparing PENG vs. FICB for pain control after hip surgeries were included in the review. Results Six RCTs were included. 133 patients received PENG block and were compared with 125 patients receiving FICB. Our analysis showed no difference in 6 h (MD: -0.19 95% CI: -1.18, 0.79 I 2 = 97% p = 0.70), 12 h (MD: 0.04 95% CI: -0.44, 0.52 I 2 = 72% p = 0.88) and 24 h (MD: 0.09 95% CI: -1.03, 1.21 I 2 = 97% p = 0.87) pain scores between PENG and FICB groups. Pooled analysis showed that mean opioid consumption in morphine equivalents was significantly less with PENG as compared to FICB (MD: -8.63 95% CI: -14.45, -2.82 I 2 = 84% p = 0.004). Meta-analysis of three RCTs showed no variation in the risk of postoperative nausea and vomiting in the two groups. The quality of evidence on GRADE was mostly moderate. Conclusion Moderate quality of evidence suggests that PENG may result in better analgesia than FICB in patients undergoing hip surgeries. Data on motor-sparing ability and complications are scarce to draw conclusions. Further large-scale and high-quality RCTs should be conducted to supplement current findings. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022350342.
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Affiliation(s)
| | | | - Danyang Yin
- Department of Anesthesiology, Taizhou Hospital of ZhejiangProvince Affiliated to Wenzhou Medical University, Linhai, China
| | - Yongqing Ye
- Department of Anesthesiology, Taizhou Hospital of ZhejiangProvince Affiliated to Wenzhou Medical University, Linhai, China
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Wang Y, Wen H, Wang M, Lu M. The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis. Pain Ther 2023; 12:81-92. [PMID: 36481969 PMCID: PMC9845468 DOI: 10.1007/s40122-022-00463-0] [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: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patients with hip surgery often experience moderate to severe postoperative pain, and need large doses of opioids to relieve it, which is not conducive to patient rehabilitation. Pericapsular nerve group (PENG) block is a new regional block technique that is considered to reduce postoperative pain and the use of opioids. The purpose of this study was to evaluate the efficacy and safety of PENG block for postoperative analgesia after hip surgery. METHODS We searched multiple databases for randomized controlled trials (RCTs) published in English, which compared PENG block with fascia iliaca compartment block (FICB). The primary outcome was 24 h postsurgical opioid consumption (OC). The secondary outcomes were pain scores (PSs) at different timepoints after surgery and the incidence of postoperative nausea and vomiting (PONV). RESULTS Five RCTs involving 234 patients were selected for our analysis. Our results show that the 24 h OC was drastically lower in PENG block versus FICB patients (SMD -0.60, 95% CI -1.08 to -0.11); P < 0.05, I2 = 69%). At the same time, there were no significant difference in postsurgical PSs between the two cohorts (6 h: MD -0.07, 95% CI -0.67 to 0.53; P = 0.82, I2 = 43%; 12 h: MD -0.60, 95% CI -1.40 to 0.19; P = 0.14, I2 = 31%; 24 h: MD 0.17, 95% CI -0.87 to 1.21; P = 0.75, I2 = 76%; 36 h: MD 0.80, 95% CI -0.92 to 2.51; P = 0.36, I2 = 73%; 48 h: MD -0.06, 95% CI -0.75 to 0.63; P = 0.86, I2 = 0%) and the incidence of PONV (RR 1.00, 95% CI 0.40-2.50, P = 1.00, I2 = 35%). CONCLUSIONS Our research shows that PENG block can reduce the use of opioids after hip surgery and is effective in postoperative analgesia. Future research should explore the injection method, concentration, and dosage.
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Affiliation(s)
- Yi Wang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Huaichang Wen
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Mengli Wang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Meijing Lu
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
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Yu L, Shen X, Liu H. The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1084532. [PMID: 36910500 PMCID: PMC9998683 DOI: 10.3389/fmed.2023.1084532] [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: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023] Open
Abstract
Background As an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery. Methods A total of 497 academic articles were identified after a systematic search in the databases of PubMed, Embase, Web of Science, and Cochrane Library up to 25 August 2022. The primary outcome was postoperative 24-h morphine consumption. Secondary outcomes included the time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and incidence of postoperative nausea and vomiting (PONV). We calculated mean differences (MDs) with 95% confidence intervals (CIs) for postoperative 24-h morphine consumption, time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and odds ratios (ORs) with 95% CIs for incidence of PONV. The chi-square test was used for heterogeneity analysis, and heterogeneity was assessed by I 2. Statistical analysis was performed using Review Manager 5.4. Results Numerous electronic databases were searched, and finally, nine studies were identified. There was no significant difference in morphine consumption during the postoperative 24 h [MD: -2.57, 95% CI: (-5.42, 0.27), P = 0.08] and the time of the first request for rescue analgesia [MD: 1.79, 95% CI: (-1.06, 4.64), P = 0.22] between the PENG block and control groups. PENG block did not reveal a significant difference in 6 h [MD: -0.17, 95% CI: (-0.92, 0.57), P = 0.65] [MD: -0.69, 95% CI: (-1.58, 0.21), P = 0.13] and 24 h [MD: -0.25, 95% CI: (-1.54, 1.05), P = 0.71], [MD: 0.05, 95% CI: (-0.84, 0.93), P = 0.91] static and dynamic pain scores compared with other nerve block methods. Moreover, the two groups have a similar risk of PONV (OR: 1.29, 95% CI = 0.53-3.10, P = 0.57). Conclusion This review shows that PENG block can act as an alternative multimodal analgesia for hip surgery, and compared with the other kinds of nerve block, there was no significant difference in the postoperative analgesic effect of PENG block. Systematic review registration Supplementary Datasheet 1, identifier: CRD 42022356496.
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology, Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Xiaojuan Shen
- Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - He Liu
- Department of Anesthesiology, Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital Huzhou University, Huzhou, China
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Hu J, Wang Q, Hu J, Kang P, Yang J. Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. J Arthroplasty 2022; 38:1096-1103. [PMID: 36529195 DOI: 10.1016/j.arth.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study examined whether pericapsular nerve group (PENG) block combined with local infiltration analgesia (LIA) could improve pain management and functional recovery after total hip arthroplasty. METHODS All patients were randomly assigned to receive PENG block combined with LIA (PENG group) or sham PENG block and LIA (Sham group). The primary outcome was cumulative morphine consumption within 24 hours after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS); time to first rescue analgesia; cumulative morphine consumption during hospitalization; intraoperative consumption of opioids; postoperative recovery; and postoperative complications. RESULTS PENG patients consumed significantly less morphine within the first 24 hours and throughout hospitalization and smaller amounts of intraoperative opioids. There were significantly lower pain scores at rest and during motion within 24 hours in PENG patients. PENG patients took significantly longer until the first rescue analgesia and showed significantly better postoperative rehabilitation. However, the absolute change in morphine consumption and VAS scores did not exceed the reported minimal clinically important differences (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement). The two groups showed no difference in quadriceps muscle strength and postoperative complications. CONCLUSION PENG block combined with LIA could improve postoperative pain relief, reduce opioid use, and enhance recovery in total hip arthroplasty patients, without weakening the quadriceps muscle strength. This work justifies further trials to examine the safety and efficacy of this block and to explore maximal effective volume of local anesthetic for motor-sparing PENG block.
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Affiliation(s)
- Jian Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Qiuru Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Hu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
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