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Sri-On J, Worawiwat T, Luksameearunothai K, Nirunsuk P, Vanichkulbodee A, Fusakul Y, Phisaiphun K, Kanokkarnjana P, Lerdruttanasoontorn D, Thong-on K. Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country. Clin Interv Aging 2024; 19:1225-1233. [PMID: 38974510 PMCID: PMC11227879 DOI: 10.2147/cia.s465006] [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: 02/20/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.
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Affiliation(s)
- Jiraporn Sri-On
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Thitarat Worawiwat
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Pornsak Nirunsuk
- Orthopedic Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Alissara Vanichkulbodee
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Yupadee Fusakul
- Department of Rehabilitation Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Krit Phisaiphun
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Pornsiri Kanokkarnjana
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Kwannapa Thong-on
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
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Grinman L, Elmore B, Ardon AE, Hussain A, Malik MF, Hernandez N, Jacoby MJ. Use of Peripheral Nerve Blocks for Total hip Arthroplasty. Curr Pain Headache Rep 2024:10.1007/s11916-024-01287-7. [PMID: 38907794 DOI: 10.1007/s11916-024-01287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations. RECENT FINDINGS Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by provider comfort, surgical approach, patient anatomy, and postoperative goals. Head-to-head studies of particular nerve blocks are warranted.
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Affiliation(s)
- Leon Grinman
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
| | - Brett Elmore
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Alberto E Ardon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Adnan Hussain
- Department of Anesthesiology and Perioperative Medicine, Henry Ford Health, Detroit, USA
| | - Mohammed Faysal Malik
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Nadia Hernandez
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
| | - Mackenzie Janice Jacoby
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
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Koh WU, Kim H, Kim YJ, Park JI, Yeo HJ, Ro YJ, Kim HJ. Comparison of analgesic effect of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block on dynamic pain in patients with hip fractures: a randomized controlled trial. Reg Anesth Pain Med 2024:rapm-2024-105627. [PMID: 38866559 DOI: 10.1136/rapm-2024-105627] [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: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Patients with hip fracture often experience severe pain, particularly during movement or slight positional change, prior to the occurrence of surgery. It is essential to explore the appropriate analgesic methods before surgery in patients with hip fracture, especially those capable of alleviating dynamic pain. Pericapsular nerve group (PENG) block was introduced as a useful technique for hip analgesia. In this study, we aimed to compare the reduction in dynamic pain between the PENG block and supra-inguinal fascia iliaca compartment block (SIFICB). METHODS This prospective trial included 80 hip fracture patients aged ≥19 years, with an American Society of Anesthesiologists Physical Status of 1-4 and a baseline dynamic pain score ≥4 on the numerical rating scale. The patients were randomly allocated into the PENG block (n=40) and SIFICB group (n=40). For the PENG block and SIFICB, 20 mL and 30 mL of 0.3% ropivacaine was used, respectively. The primary outcome was reduction in dynamic pain scores at 30 min following the peripheral nerve block. Dynamic pain score was evaluated when the leg was passively raised. RESULTS A total of 79 patients were included in the final analysis, and the reductions in pain score during hip flexion were 3.1±2.4 and 2.9±2.5 in the PENG block and SIFICB groups, respectively, which was statistically insignificant (p=0.75). Moreover, no significant differences were observed in any of the outcomes. CONCLUSIONS PENG block and SIFICB could effectively provide analgesia for dynamic pain in patients with hip fractures, with no significant difference between the two groups. TRIAL REGISTRATION NUMBER NCT04677348.
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Affiliation(s)
- Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Ju Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji In Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jin Yeo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha-Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Lee TS, Kwon HM, Park JY, Park MC, Choi YS, Park KK. Evaluating Pain Management from Peripheral Nerve Block for Geriatric Patients following Bipolar Hemiarthroplasty for Displaced Femoral-Neck Fracture. Gerontology 2024; 70:603-610. [PMID: 38574472 PMCID: PMC11177891 DOI: 10.1159/000538614] [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: 07/03/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate peripheral nerve block (PNB) effectiveness in postoperative pain management and surgical outcomes for displaced femoral-neck fracture in geriatric patients (>70 years) who underwent bipolar hemiarthroplasty (BHA). METHODS From January 2017 to December 2021, 231 geriatric patients with displaced femoral-neck fracture who consecutively underwent BHA were retrospectively reviewed. Patients were divided into two groups: the patient-controlled analgesia (PCA) group (n = 132) who received only intravenous (IV) PCA for postoperative pain management, and all others who received PNB with IV PCA (PNB+PCA) such as femoral nerve block or fascia iliaca compartment block after surgery (n = 99). Primary outcomes were postoperative visual analog scale (VAS) at rest and during activity at 6, 24, and 48 h postoperatively. Secondary outcomes were postoperative complications, changes in hemoglobin, length of hospital stay, and total morphine usage after surgery. RESULTS Postoperative resting VAS at 6 h and 48 h was significantly lower in the PNB+PCA group compared with the PCA group (p = 0.075, p = 0.0318, respectively). However, there was no significant difference in either resting VAS at 24 h or active VAS. Complications of pneumonia and delirium until 1 month postoperative were significantly lower in the PNB + PCA group than the PCA group (p = 0.0022, p = 0.0055, respectively). CONCLUSION PNB with IV PCA seems to have a beneficial effect on geriatric femoral-neck patients who underwent BHA with postoperative analgesia for reducing postoperative resting pain and complications, especially pneumonia and delirium.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Young Park
- Department of Orthopedic Surgery, Yong-in Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Cheol Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Girombelli A, Vetrone F, Saglietti F, Galimberti A, Fusaro A, Umbrello M, Pezzi A. Pericapsular nerve group block and lateral femoral cutaneous nerve block versus fascia iliaca block for multimodal analgesia after total hip replacement surgery: A retrospective analysis. Saudi J Anaesth 2024; 18:218-223. [PMID: 38654885 PMCID: PMC11033891 DOI: 10.4103/sja.sja_881_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: 11/07/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 04/26/2024] Open
Abstract
Background Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. Methods We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. Results 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. Conclusions PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.
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Affiliation(s)
- Alessandro Girombelli
- Department of Anesthesiology, Division of Anesthesiology, Intensive Care and Emergency Medicine, EOC, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Francesco Vetrone
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
| | - Francesco Saglietti
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera S. Croce e Carle, Cuneo (CN), Italy
| | - Andrea Galimberti
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
| | - Andrea Fusaro
- Orthopedic Surgery Division, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo (MI), Italy
| | - Michele Umbrello
- Anesthesiology and Critical Care Medicine, SC Anestesia e Rianimazione II, ASST Santi Paolo e Carlo – Polo Universitario, Ospedale San Carlo Borromeo, Milano (MI), Italy
| | - Angelo Pezzi
- Department of Surgery and Emergency, Anesthesiology and Critical Care Medicine, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo (MI), Italy
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Lee B, Lee TS, Jang J, Jung HE, Park KK, Choi YS. A Randomized Controlled Trial to Evaluate the Analgesic Effectiveness of Periarticular Injections and Pericapsular Nerve Group Block for Patients Undergoing Total Hip Arthroplasty. J Pers Med 2024; 14:377. [PMID: 38673004 PMCID: PMC11051520 DOI: 10.3390/jpm14040377] [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: 03/16/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Pericapsular nerve group (PENG) block and periarticular injection (PAI) provide motor-sparing analgesia following hip surgery. We hypothesized that PAI offers non-inferior pain relief compared with PENG block in patients undergoing primary total hip arthroplasty (THA). In this randomized trial, 66 patients who underwent primary THA under spinal anesthesia were assigned to the PENG or PAI groups. The primary endpoint was the resting pain score 24 h postoperatively. The secondary endpoints included pain scores at rest and during movement at 6 and 48 h postoperatively, quadriceps strength at 24 h postoperatively, and opioid consumption at 24 and 48 h postoperatively. The mean difference in pain scores at rest between the two groups was 0.30 (95% confidence interval [CI], -0.78 to 1.39) at 24 h postoperatively. The upper 95% CI was lower than the non-inferiority margin, indicating non-inferior performance. No significant between-group differences were observed in the pain scores at 6 and 48 h postoperatively. Additionally, no significant differences in quadriceps strength and opioid consumption were observed between the two groups. The PAI and PENG blocks provided comparable postoperative analgesia during the first 48 h after primary THA. Further investigation is required to determine the optimal PAI technique and local anesthetic mixture.
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Affiliation(s)
- Bora Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jaewon Jang
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyun Eom Jung
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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9
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Diwan S, Shivamallappa S, Timane R, Pai P, Gupta A. Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers. J Anesth 2024:10.1007/s00540-024-03333-5. [PMID: 38466404 DOI: 10.1007/s00540-024-03333-5] [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: 10/24/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. METHODS A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24 h later to assess the extent of dye spread. RESULTS Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection. CONCLUSION The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.
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Affiliation(s)
- Sandeep Diwan
- Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | | | - Rasika Timane
- Department of Anaesthesia and critical care, Critizone Hospital, Nagpur, Maharashtra, India
| | - Pallavi Pai
- Department of Anaesthesiology, Dinanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), No. 6, 4th Floor, Porta Cabin, Teaching Block, New Delhi, 110029, 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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Yoo SH, Lee MJ, Beak MH, Kim WJ. Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:315. [PMID: 38399602 PMCID: PMC10889980 DOI: 10.3390/medicina60020315] [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: 01/04/2024] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral incision, affecting the cutaneous supply by branches of the lateral femoral cutaneous nerve (LFCN), the LFCN block can contribute to postoperative analgesia. However, no studies have investigated the effectiveness of supplemental PENG block combined with LFCN block in patients undergoing LIA after hip fracture surgery. Our study aimed to assess the effectiveness of PENG combined with LFCN block following hip fracture surgery in patients who underwent LIA. Materials and Methods: Forty-six patients were randomly assigned to LIA or PENG + LFCN + LIA groups. The primary outcome was the pain score at rest and during movement at 2, 6, 12, 24, and 48 h postoperatively. The total opioid dose for postoperative analgesia was also measured at the same time points. Secondary outcomes included postoperative cognitive function assessment. Results: The median pain scores at rest and during movement were lower in the PENG + LFCN + LIA group throughout the study periods compared to the LIA group, except at 2 h (at rest) and 48 h (during movement) after surgery. The total fentanyl dose was lower in the PENG + LFCN + LIA group at all time points after surgery when compared to the LIA group. Postoperative delirium incidence and the median abbreviated mental test scores were not significantly different between the two groups. Conclusions: The combination of PENG and LFCN blocks may contribute to enhanced recovery for patients undergoing LIA after hip fracture surgery. However, further well-controlled research is necessary to determine the effectiveness of supplemental PENG combined with LFCN block in addressing cognitive deficits in these patients.
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Affiliation(s)
- Seung-hee Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul 07985, Republic of Korea; (S.-h.Y.); (M.-h.B.)
| | - Min-jin Lee
- Department of Anesthesiology and Pain Management, Yong-Chul Kim’s Pain Clinic, Seoul 03079, Republic of Korea;
| | - Min-hyouk Beak
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul 07985, Republic of Korea; (S.-h.Y.); (M.-h.B.)
| | - Won-joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul 07985, Republic of Korea; (S.-h.Y.); (M.-h.B.)
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Souvatzoglou R, Saranteas T, Poulogiannopoulou E, Mavrogenis AF. Ultrasound-Guided Peripheral Nerve Blocks for Hip Surgery: A Concise Perspective. J Long Term Eff Med Implants 2024; 34:49-58. [PMID: 37938205 DOI: 10.1615/jlongtermeffmedimplants.2023045538] [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: 02/11/2023]
Abstract
Ultrasound implementation for the facilitation of peripheral nerve blocks is well established. Ultrasound-guided lumbar plexus, femoral, fascia iliaca and supra-inguinal fascia iliaca compartment, pericapsular nerve group and quadratus lumborum nerve blocks have been employed for analgesia purposes in hip surgery. The combination of motor-sparing regional anesthesia strategies for optimal postoperative pain control with recovery protocols targeting to early and safe patients' mobilization constitute the current dogma of orthopedic surgery. Therefore, this editorial sets out to revisit the role of peripheral nerve blocks in postoperative pain management of hip surgery patients, under the prism of current orthopedic practice.
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Affiliation(s)
- Rizos Souvatzoglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleni Poulogiannopoulou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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13
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Amin SR, Ahmed F. Comparison between pericapsular nerve group block and fascia iliaca compartment block for perioperative pain control in hip surgeries: A meta-analysis from randomized controlled trials. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2180540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- Samar Rafik Amin
- Department of Anesthesia, Faculty of Medicine, Benha University, Benha, Egypt
| | - Fatma Ahmed
- Department of Anesthesia, Faculty of Medicine, Benha University, Benha, Egypt
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Nuthep L, Klanarong S, Tangwiwat S. The Analgesic effect of adding ultrasound-guided pericapsular nerve group block to suprainguinal fascia iliaca compartment block for hip fracture surgery: A prospective randomized controlled trial. Medicine (Baltimore) 2023; 102:e35649. [PMID: 37932971 PMCID: PMC10627608 DOI: 10.1097/md.0000000000035649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Both suprainguinal ultrasound-guided fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block have been used to treat pain after hip surgery. Motor-sparing PENG block may further expedite early postoperative rehabilitation. This study aimed to compare the analgesic efficacy and recovery outcome of suprainguinal ultrasound-guided FICB alone with FICB combined with PENG block for hip fracture surgery. METHODS In this study, 59 elderly patients undergoing hip fracture surgery were randomized to receive either FICB alone or combined FICB + PENG block. The primary outcome was pain score at rest 12 hours after surgery as measured by the numerical rating scale (NRS, 0-10) and secondary outcomes were pain scores at rest and with movement measured at other time points within 48 hours, time to first sit up without pain, rescue morphine requirements, opioid-related side effects, incidence of delirium, in-hospital morbidities and mortality, and length of hospital stay. RESULTS Both patient groups had similar demographic profile and postoperative pain scores at rest and with movement. Median NRS pain scores at rest between FICB alone or combined FICB + PENG block at 4, 8, 12, 24, 36 and 48 hours after surgery were 3 versus 3 (P = .31), 3 versus 3 (P = .21) and 3 versus 3 (P = .69), 2 versus 2 (P = .35), 2 versus 3 (P = .17), 3 versus 2 (P = .18) respectively and NRS during movement at 12, 24, 48 hours were 10 versus 8 (P = .30), 6 versus 5 (P = .54) and 3.5 versus 2.0 (P = .64), respectively. There was also no significant difference in the time for patients to first sit up without pain (17.50 vs 19.37 hours vs h; P = .058) or any other secondary outcome measures. The procedure time was, however, significantly longer for the FICB + PENG block (10 vs 5 minutes, P < .001). CONCLUSION Addition of ultrasound-guided PENG block to FICB did not improve postoperative analgesic or recovery outcomes in elderly patients undergoing hip fracture surgery.
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Affiliation(s)
- Luckapa Nuthep
- Department of Anesthesiology, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Suwattana Klanarong
- Department of Anesthesiology, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Prakash J, Rochwerg B, Saran K, Yadav AK, Bhattacharya PK, Kumar A, Chaudhuri D, Priye S. Comparison of analgesic effects of pericapsular nerve group block and fascia iliaca compartment block during hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth 2023; 67:962-972. [PMID: 38213682 PMCID: PMC10779973 DOI: 10.4103/ija.ija_672_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: 07/13/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Postoperative pain for patients having hip arthroplasty ranges from moderate to severe. Many regional anaesthesia procedures treat postoperative pain to improve functional ability and quality of life. Evidence comparing the analgesic effects of the pericapsular nerve group (PENG) block and fascia iliaca compartment block (FICB) remains unclear. The analgesic efficacies of PENG and FICB in hip arthroplasty were compared to determine which technique is associated with superior analgesia. Methods The electronic databases (PubMed, Cochrane Library, Google Scholar and Web of Sciences) were searched for published randomised controlled trials (RCTs) till 5 April 2023 comparing PENG block vs. FICB following hip arthroplasty. The primary outcome was pain scores [numerical rating scale (NRS) or visual analogue scale (VAS)] between 0 and 10 at rest and during movement at 24 h. Secondary outcomes included pain scores at rest and during movement within 30 min, at 6 h and 12 h, time to first rescue analgesia and cumulative postoperative opioid use in 24 h. We assessed the risk of bias using the Cochrane Collaboration Risk-of-Bias 2 tool. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the certainty of the evidence was assessed. Subgroup analysis was performed to explore the source of heterogeneity. Results We included 12 RCTs examining 644 patients. Pain scores at rest at 24 h (standardised mean differences (SMDs): 0.17; 95% confidence interval (CI): -0.90 to 1.23; P = 0.76, moderate certainty) and during movement at 24 h (SMD: -0.58, 95% CI: -1.53 to 0.38, P = 0.24, moderate certainty) were not different in both PENG block and FICB. Pain scores at rest and during movement within 30 min may be lower with PENG block than FICB. However, the pain score at rest and during movement at 6 h and the time to first rescue analgesia were not different between the two treatment arms. The mean opioid consumption in oral morphine equivalents (mg) in 24 h may be lower with PENG than FICB. Conclusion We observed no difference between the PENG block and the FICB at 24 h for pain at rest and movement with a moderate degree of certainty. However, PENG block showed improved analgesia within 30 min at rest and during movement, and reduce postoperative opioid consumption in 24 h with moderate certainty of evidence. Further large-scale and high-quality RCTs are required to supplement the present findings.
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Affiliation(s)
- Jay Prakash
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Bram Rochwerg
- Department of Medicine (Division of Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Khushboo Saran
- Department of Pathology, Gandhi Nagar Hospital, Central Coalfield, Kanke, Ranchi, Jharkhand, India
| | - Arun K. Yadav
- Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Dipayan Chaudhuri
- Department of Medicine (Division of Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Shio Priye
- Superspeciality Anaesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Domagalska M, Ciftci B, Reysner T, Kolasiński J, Wieczorowska-Tobis K, Kowalski G. Pain Management and Functional Recovery after Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty: A Prospective, Randomized, Double-Blinded Clinical Trial. J Clin Med 2023; 12:4931. [PMID: 37568331 PMCID: PMC10420102 DOI: 10.3390/jcm12154931] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The immediate postoperative period after total hip arthroplasty can be associated with significant pain. Therefore, this study aimed to evaluate the effect of pericapsular nerve block on pain management and functional recovery after total hip arthroplasty. METHODS This prospective, randomized, double-blinded, placebo-controlled trial was conducted on 489 adult patients scheduled for total hip arthroplasty, ASA 1-2, operated under spinal analgesia. Participants were assigned to receive either a pericapsular nerve group (PENG) block with 20 mL of 0.5% ropivacaine or a sham block. RESULTS The primary outcome measure was the postoperative NRS score in motion. The secondary outcomes were cumulative opioid consumption, the time to the first opioid, and functional recovery. Demographic characteristics were similar in both groups. Intraoperative pain scores were significantly lower in patients who received the PENG block than in the control group (p < 0.0001). Also, the time to the first opioid was considerably longer in the PENG group (p < 0.0001). Additionally, 24% of PENG patients did not require opioids (p < 0.0001). CONCLUSIONS The pericapsular nerve group showed significantly decreased opioid consumption and improved functional recovery. Pericapsular nerve group block improved pain management and postoperative functional recovery following total hip arthroplasty.
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Affiliation(s)
- Małgorzata Domagalska
- Department of Palliative Medicine, University of Medical Sciences, 61-245 Poznan, Poland; (T.R.); (K.W.-T.); (G.K.)
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul 34214, Turkey;
| | - Tomasz Reysner
- Department of Palliative Medicine, University of Medical Sciences, 61-245 Poznan, Poland; (T.R.); (K.W.-T.); (G.K.)
| | | | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, University of Medical Sciences, 61-245 Poznan, Poland; (T.R.); (K.W.-T.); (G.K.)
| | - Grzegorz Kowalski
- Department of Palliative Medicine, University of Medical Sciences, 61-245 Poznan, Poland; (T.R.); (K.W.-T.); (G.K.)
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Lee TS, Park KK, Cho BW, Lee WS, Kwon HM. Silicone ring tourniquet could be a substitute for a conventional tourniquet in total knee arthroplasty with a longer surgical field: a prospective comparative study in simultaneous total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:363. [PMID: 37161363 PMCID: PMC10169314 DOI: 10.1186/s12891-023-06469-9] [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: 10/11/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION This study aimed to compare the clinical outcomes of silicon ring tourniquets and conventional pneumatic tourniquets in total knee arthroplasty (TKA). The study compared the operation time, total bleeding amount, length from the tourniquet distal end to the patella superior pole (L_TP), and complications related to the two tourniquet application methods and attempted to determine whether the silicon ring tourniquet has advantages over conventional pneumatic tourniquets. MATERIALS AND METHODS This prospective comparative study included 30 patients who underwent bilateral simultaneous TKA for degenerative osteoarthritis in August to December 2021. All patients underwent TKA on one side with a conventional pneumatic tourniquet, while TKA on the other side with a silicon ring tourniquet. The primary outcomes were the L_TP, operation time, tourniquet time, total bleeding amount, total drainage amount, and postoperative visual analog scale (VAS) score of the tourniquet applied site at 6, 24, and 48 h postoperatively. The secondary outcome was tourniquet-related complications in both groups. RESULTS L_TP was significantly longer in the silicon ring tourniquet group compared with that in the pneumatic tourniquet group (20.22 ± 2.74 cm versus 15.12 ± 2.40, p < 0.001). No significant difference was found in other results. The tourniquet applied site pain was less in the silicon ring tourniquet group (p = 0.037). CONCLUSIONS Silicon ring tourniquet application resulted in better clinical outcomes than conventional pneumatic tourniquets in TKA. Because we can obtain a wider surgical field using silicon ring tourniquets without complications, silicon ring tourniquets could be a substitute for conventional pneumatic tourniquets in total knee arthroplasty or distal femoral surgeries.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Byung Woo Cho
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Desai DJ, Shah N, Bumiya P. Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series. Cureus 2023; 15:e36374. [PMID: 37090404 PMCID: PMC10113177 DOI: 10.7759/cureus.36374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery. METHOD We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively. RESULT The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. CONCLUSION Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.
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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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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.
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Affiliation(s)
- Ahmed Farag
- Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt.
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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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Zheng J, Du L, Chen G, Zhang L, Deng X, Zhang W. Efficacy of pericapsular nerve group (PENG) block on perioperative pain management in elderly patients undergoing hip surgical procedures: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2023; 13:e065304. [PMID: 36604133 PMCID: PMC9827252 DOI: 10.1136/bmjopen-2022-065304] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION An increasing number of elderly patients suffer from hip diseases associated with moderate to severe perioperative pain during the accelerating global ageing process. Optimal analgesia can decrease perioperative complications and facilitate elderly patients' perioperative recovery. Pericapsular nerve group (PENG) block is a relatively new, analgesia adequate and motor-sparing block technique for perioperative pain management of hip diseases. However, the efficacy of PENG block remains unclear as the limited clinical evidence. Then, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of PENG block for perioperative pain management. METHODS AND ANALYSIS PubMed, Ovid Medline, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases will be searched from inception to August 2022 to identify randomised controlled trials of elderly patients accepting PENG block for hip diseases. The primary outcome will be the pain intensity after pain management. Secondary outcomes will be quadriceps strength, perioperative rescue analgesia information and perioperative complications. Assessment of heterogeneity will be primarily inspected by forest plots. If there is no indication of funnel plot asymmetry, a random-effects meta-analysis will be performed. The Cochrane risk-of-bias tool, Grading of Recommendations Assessment, Development and Evaluation and trial sequential analysis will be conducted to evaluate the evidence quality and control the random errors. Funnel plots and Egger's regression test will be performed to evaluate publication bias. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42022313895.
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Affiliation(s)
- Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital and Research Institute, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 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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Peripheral Nerve Block for Pain Management after Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching. J Clin Med 2022; 11:jcm11185456. [PMID: 36143103 PMCID: PMC9505421 DOI: 10.3390/jcm11185456] [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: 08/13/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided into two groups: the patient-controlled analgesia (PCA) group (n = 217) who received only intravenous (IV) analgesia, and others who received IV PCA and PNB (PCA + PNB group) (n = 136). After propensity score matching for age and sex, 136 patients from each group were included in the study. Primary outcomes were the visual analogue scale (VAS) at rest, activity status at postoperative 6, 24, 48 h. Secondary outcomes were functional scores by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and rescue medications used. The postoperative VAS at 6, 24, 48 h at rest and 6 h at activity were significantly lower in the PCA + PNB group (p = 0.000, 0.001, 0.000, 0.004 in order). There was no significant difference for postoperative 3-month HHS (p = 0.218), except for 3-month WOMAC index (p = 0.001). There were no significant differences for VAS between the PNB methods except femoral nerve block (FNB) and fascia iliaca compartment block (FICB) at postoperative activity 48 h (p = 0.028). There was no significant difference in the total count and amount of rescue medication (p = 0.091, 0.069) and difference in the quadriceps weakness was not noted. Therefore, PNB is beneficial for patients who undergo THA as it provides sufficient postoperative analgesia, especially during immediate postoperative resting pain without quadriceps weakness.
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Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks. Healthcare (Basel) 2022; 10:healthcare10081565. [PMID: 36011222 PMCID: PMC9408030 DOI: 10.3390/healthcare10081565] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/18/2023] Open
Abstract
Iliopsoas plane (IP) is a fascial plane deep to the iliopsoas complex that can serve as a potential space for the injection of local anesthetics to selectively block the articular branches of femoral nerve and accessory obturator nerve to the anterior hip capsule. Two highly similar ultrasound-guided interfascial plane blocks that target the IP, pericapsular nerve group (PENG) block and iliopsoas plane block (IPB), were both designed to achieve motor-sparing sensory block to the anterior hip capsule. However, the most recent evidence shows that PENG block can cause 25% or more of quadriceps weakness, while IPB remains the hip block that can preserve quadriceps strength. In this scoping review of quadriceps weakness after PENG block and IPB, we first performed a focused review on the complicated anatomy surrounding the anterior hip capsule. Then, we systematically searched for all currently available cadaveric and clinical studies utilizing PENG block and IPB, with a focus on quadriceps weakness and its potential mechanism from the perspectives of fascial plane spread along and outside of the IP. We conclude that quadriceps weakness after PENG block, which places its needle tip directly deep to iliopsoas tendon (IT), may be the result of iliopectineal bursal injection. The incidental bursal injection, which can be observed on ultrasound as a medial fascial plane spread, can cause bursal rupture/puncture and an anteromedial extra-IP spread to involve the femoral nerve proper within fascia iliaca compartment (FIC). In comparison, IPB places its needle tip lateral to IT and injects just one-fourth of the volume of PENG block. The current evidence, albeit still limited, supports IPB as the true motor-sparing hip block. To avoid quadriceps weakness after PENG block, a more laterally placed needle tip, away from the undersurface of IT, and a reduction in injection volume should be considered. Future studies should focus on comparing the analgesic effects and quadriceps function impairment between PENG block and IPB.
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