Advantages and issues of concern regarding approaches to peripheral nerve block for total hip arthroplasty

An ultrasound-guided modified iliac fascia and sacral plexus block application in a critically ill patient undergoing artificial femoral head replacement surgery: a case report

BACKGROUND

Hip fractures have become a significant clinical concern on a global scale in recent years. The burgeoning aging population has exacerbated this issue, leading to a rise in the number of hip fracture cases coupled with concomitant geriatric ailments. Therefore, it poses a huge challenge to anesthesiologists with the increasing number of critically ill patients who are not suitable for general anesthesia and intrathecal anesthesia. Ultrasound-guided nerve blocks combined with sedation have not previously been documented in critically ill patients.

CASE PRESENTATION

We administered an ultrasound-guided modified iliac fascia block combined with sacral plexus block to an 88-year-old male patient with a left femoral fracture suffering from severe multi-systemic diseases. Concurrently, the patient received intravenous anesthesia via propofol and dexmedetomidine, with monitoring conducted through bispectral index. Subsequently, the surgery was completed smoothly and the patient demonstrated accelerated postoperative recovery without significant discomfort and a successful discharge.

CONCLUSIONS

This innovative approach significantly contributed to achieving successful surgical anesthesia and postoperative analgesia, thereby facilitating early recovery and discharge from the hospital. We propose that ultrasound-guided nerve blocks with sedation show promise for critically ill patients.

Pericapsular Nerve Group (PENG) Block Results in Significant Opioid Reduction in Total Hip Arthroplasty: A Retrospective Analysis

PURPOSE

The purpose of this retrospective study was to determine the effectiveness of pericapsular nerve group (PENG) block for pain control intraoperatively in patients undergoing total hip arthroplasty (primary-27130) (THA), compared to opioid based analgesia. The PENG block is an emerging regional anesthesia technique that aims to provide hip analgesia with preservation of motor function offering benefit over existing regional techniques while reducing overall opioid requirements.

DESIGN

A retrospective cohort chart review and analysis.

METHODS

A single-site, retrospective chart review was performed for individuals undergoing THAs at a community hospital from 2019 to 2022 (N = 123). Anesthesia records were collected and observed for multiple data points including peripheral nerve block provided, micrograms of fentanyl administered before and during the case, additional medications given, and additional nerve blocks performed. The demographic data included birth date, sex, and procedure date.

FINDINGS

For statistical analysis only, patients receiving PENG (59) were compared to those receiving only intravenous analgesia (No Block-57). Statistically and clinically significant reductions in fentanyl administration and morphine equivalents were found in the population receiving PENG blocks. The mean intraoperative fentanyl given to the No Block group was 292.98 mcg versus 50.42 mcg in the PENG group (P < .05). Mean morphine equivalents given in the No Block group was 23.51 mg versus 11.21 mg in the PENG group (P < .05).

CONCLUSIONS

Receiving a PENG block preoperatively resulted in clinically and statistically significant opioid reduction during the perioperative period when compared with patients who did not receive a regional block.