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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; 38:445-454. [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] [MESH Headings] [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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Hayashi M, Yamamoto N, Kuroda N, Kano K, Miura T, Kamimura Y, Shiroshita A. Peripheral Nerve Blocks in the Preoperative Management of Hip Fractures: A Systematic Review and Network Meta-Analysis. Ann Emerg Med 2024; 83:522-538. [PMID: 38385910 DOI: 10.1016/j.annemergmed.2024.01.024] [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: 10/15/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
STUDY OBJECTIVE We conducted a systematic review and network meta-analysis to evaluate the comparative efficacy of peripheral nerve block types for preoperative pain management of hip fractures. METHODS We searched Cochrane, Central Register of Controlled Trials, MEDLINE, EMBASE, ICTRP, ClinicalTrials.gov, and Google Scholar for randomized clinical trials. We included participants aged more than 16 years with hip fractures who received peripheral nerve blocks or analgesics for preoperative pain management. The primary outcomes were defined as absolute pain score 2 hours after block placement, preoperative consumption of morphine equivalents, and length of hospital stay. We used a random-effects network meta-analysis conceptualized in the Bayesian framework. Confidence of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). RESULTS We included 63 randomized controlled studies (4,778 participants), of which only a few had a low risk of bias. The femoral nerve block, 3-in-1 block, fascia iliaca compartment block, and pericapsular nerve group block yielded significantly lowered pain scores at 2 hours after block placement compared with those with no block (standardized mean differences [SMD]: -1.1; 95% credible interval [CrI]: -1.7 to -0.48, [confidence of evidence: low]; SMD: -1.8; 95% CrI: -3.0 to -0.55, [low]; SMD: -1.4; 95% CrI: -2.0 to -0.72, [low]; SMD: -2.3; 95% CrI: -3.2 to -1.4, [moderate], respectively). The pericapsular nerve group block, 3-in-1 block, fascia iliaca compartment block, and femoral nerve block resulted in lower pain scores than the no-block group. Additionally, the pericapsular nerve group block yielded a lower pain score than femoral nerve block or fascia iliaca compartment block (SMD: -1.21; 95% CrI: -2.18 to -0.23, [very low]: SMD: -0.92; 95% CrI: -1.70 to -0.16, [low]). However, both the fascia iliaca compartment block and femoral nerve block did not show a reduction in morphine consumption compared with no block. To our knowledge, no studies have compared the pericapsular nerve group block with other methods regarding morphine consumption. Furthermore, no significant difference was observed between peripheral nerve blocks and no block in terms of the length of hospital stay. CONCLUSIONS Compared with no block, preoperative peripheral nerve blocks for hip fractures appear to reduce pain 2 hours after block placement. Comparing different blocks, pericapsular nerve group block might be superior to fascia iliaca compartment block and femoral nerve block for pain relief, though the confidence evidence was low in most comparisons because of the moderate to high risk of bias in many of the included studies and the high heterogeneity of treatment strategies across studies. Therefore, further high-quality research is needed.
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Affiliation(s)
- Minoru Hayashi
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Naoto Kuroda
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Pediatrics, Wayne State University, Detroit, MI; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kano
- Department of Emergency Medicine Fukui Prefectural Hospital, Yotsui, Fukui, Japan
| | - Takanori Miura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan
| | - Yuji Kamimura
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Anesthesiology and Intensive Care Medicin, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Shiroshita
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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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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Casas Reza P, Gestal Vázquez M, Sampayo Rodríguez L, Vilar Castro A, López-López D, García Romar A. Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:160-170. [PMID: 38354775 DOI: 10.1016/j.redare.2024.02.011] [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: 10/07/2022] [Accepted: 07/08/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.
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MESH Headings
- Humans
- Retrospective Studies
- Pain, Postoperative/prevention & control
- Pain, Postoperative/epidemiology
- Pain, Postoperative/drug therapy
- Arthroplasty, Replacement, Hip
- Male
- Female
- Nerve Block/methods
- Aged
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Middle Aged
- Anesthesia, Conduction/methods
- Morphine/administration & dosage
- Morphine/therapeutic use
- Clinical Audit
- Femoral Nerve
- Anesthetics, Local/administration & dosage
- Aged, 80 and over
- Hip Fractures/surgery
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Affiliation(s)
- P Casas Reza
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
| | - M Gestal Vázquez
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - L Sampayo Rodríguez
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - A Vilar Castro
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - D López-López
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - A García Romar
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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Jeevendiran A, Suganya S, Sujatha C, Rajaraman J, R S, Asokan A, A R. Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study. Cureus 2024; 16:e56270. [PMID: 38623129 PMCID: PMC11017796 DOI: 10.7759/cureus.56270] [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: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Hip fractures cause severe pain during positioning for spinal anesthesia (SA). Intravenous systemic analgesics can lead to various complications in elderly patients, hence peripheral nerve blocks are emerging as a standard of care in pain management for hip fractures, among which femoral nerve block (FNB) is widely known and practiced. Pericapsular nerve group (PENG) block is a recently described technique that blocks the articular nerves of the hip with motor-sparing effects and is used to manage positional pain in hip fractures. This study aims to evaluate the analgesic efficacy of PENG block over FNB in managing pain during positioning before SA in hip fractures. MATERIALS AND METHODS This was a prospective, randomized, double-blinded study. After ethical clearance, 70 patients undergoing hip fracture surgery under SA in a tertiary-care hospital were recruited and randomized to receive either ultrasound-guided PENG block or FNB with 20 ml of 0.25% bupivacaine before performing SA. We compared pain severity using the visual analog scale (VAS) 15 and 30 minutes after the block and during positioning. The sitting angle, requirement of rescue analgesia for positioning, and anesthesiologist and patient satisfaction scores were also analyzed. Continuous data were analyzed with an unpaired t-test while the chi-square test was used for categorical data. RESULTS There was a significant reduction in VAS scores after PENG block (PENG: 0.66 ± 1.05 and FNB: 1.94 ± 1.90; p = 0.001) with lesser requirement of rescue analgesia for positioning compared to FNB. The anesthesiologist and patient satisfaction scores were also significantly better in the PENG group. CONCLUSION PENG block offers better analgesia for positioning before SA than FNB without any significant side effects, and improves patient and anesthesiologist satisfaction, thus proving to be an effective analgesic alternative for painful hip fractures.
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Affiliation(s)
- Annamale Jeevendiran
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Srinivasan Suganya
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Chinthavali Sujatha
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Jayashridevi Rajaraman
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Surya R
- Anaesthesiology and Critical Care, Saveetha Medical College and Hospital, Chennai, IND
| | - Arthi Asokan
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Radhakrishnan A
- Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
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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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Keskes M, Ali Mtibaa M, Abid A, Sahnoun N, Ketata S, Derbel R, Zouche I, Cheikhrouhou H. Pericapsular nerve group block versus fascia iliaca block for perioperative analgesia in hip fracture surgery: a prospective randomized trial. Pan Afr Med J 2023; 46:93. [PMID: 38405096 PMCID: PMC10891367 DOI: 10.11604/pamj.2023.46.93.41117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 02/27/2024] Open
Abstract
The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.
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Affiliation(s)
- Mariem Keskes
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Mohamed Ali Mtibaa
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Ameur Abid
- Department of Orthopedic Surgery, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Nizar Sahnoun
- Department of Orthopedic Surgery, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Salma Ketata
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Rahma Derbel
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Imen Zouche
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
| | - Hichem Cheikhrouhou
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, 3000 Sfax, Tunisia
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Tang Y, Zhang X, Yi S, Li D, Guo H, Liu Y, Liu J, Kong M. Ultrasound-guided pericapsular nerve group (PENG) block for early analgesia in elderly patients with hip fractures: a single-center prospective randomized controlled study. BMC Anesthesiol 2023; 23:383. [PMID: 37996789 PMCID: PMC10666449 DOI: 10.1186/s12871-023-02336-1] [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: 03/01/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the efficacy of ultrasound-guided PENG (pericapsular nerve group) block and drug therapy with intravenous flurbiprofen for early analgesia in elderly patients with hip fractures after hospitalization. METHODS This is a single-center, observer-blinded, prospective, randomized, controlled trial. A total of 41 elderly patients (aged 60 or older) with hip fractures were enrolled in the current study. Patients were randomly assigned to two groups: Group P (ultrasound-guided PENG block, 20 mL of 0.375% ropivacaine) and Group F (intravenous flurbiprofen 50 mg). The primary outcome measure was the dynamic (passive straight leg raising 15°) NRS (numerical rating scale 0 to 10) pain scores at different time points. The secondary outcomes were the static NRS scores at different time points, the number of rescue analgesia sessions, patient satisfaction, and the incidence of complications. RESULTS Patients in the two groups had comparable baseline characteristics. The group P had lower dynamic and static NRS scores at 15 min, 30 min, 6 h, and 12 h after intervention (P<0.05) than the group F. The highest NRS pain scores in the group P were still lower than the NRS scores in the group F at 30 min-12 h (Group F: 5.57±1.54 vs. Group P: 3.00±1.12, P<0.001), and there was no significant difference between the two groups at 12-24 h (Group F: 6.35±1.79 vs. Group P: 5.90±1.83, P>0.05). The group P had higher satisfaction scores (Group P: 9 (9,9) vs. Group F: 8 (7,8), P<0.001). There was no statistically significant difference in the number of rescue analgesics at 0-12 h or 12-24 h or the incidence of complications between the groups. CONCLUSIONS Compared with intravenous flurbiprofen, ultrasound-guided PENG block provides better early analgesic effects in elderly patients with hip fractures, and a PENG block is safe for elderly patients with hip fractures after hospitalization. Trial registration This study was registered in the Chinese Clinical Trial Testing Center (ID: ChiCTR2200062400).
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Affiliation(s)
- Yan Tang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Xinlei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Shuai Yi
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Dan Li
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huai Hai West Road, Xuzhou, Jiangsu Province, China
| | - Hui Guo
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Yunqing Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China
| | - Jindong Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huai Hai West Road, Xuzhou, Jiangsu Province, China
| | - Mingjian Kong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32, Meijian Road, Xuzhou, Jiangsu Province, China.
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Pavithran P, Sekhar B, Shameer M, Kumar P. Continuous pericapsular nerve group block with single-shot lateral femoral cutaneous nerve block for total hip arthroplasty. Indian J Anaesth 2023; 67:S302-S303. [PMID: 38187982 PMCID: PMC10768918 DOI: 10.4103/ija.ija_567_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
| | - Biju Sekhar
- Department of Anaesthesiology, Aster MIMS, Calicut, Kerala, India
| | - Moidu Shameer
- Department of Orthopaedics, Aster MIMS, Calicut, Kerala, India
| | - Pradeep Kumar
- Department of Orthopaedics, Aster MIMS, Calicut, Kerala, India
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10
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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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11
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Andrade PP, Lombardi RA, Marques IR, Braga ACDNAE, Isaias BRS, Heiser NE. Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:794-809. [PMID: 37507071 PMCID: PMC10625158 DOI: 10.1016/j.bjane.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. METHODS Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. CONCLUSION The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO REGISTRATION CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.
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Affiliation(s)
- Priscila P Andrade
- Hospital Regional de Sorocaba Adib Domingos Jatene, Divisão de Anestesiologia, Sorocaba, SP, Brazil
| | - Rafael A Lombardi
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America.
| | - Isabela R Marques
- Universitat Internacional de Catalunya, Division of Medicine, Barcelona, Spain
| | | | - Beatrice R S Isaias
- Universidade Federal de Mato Grosso do Sul, Divisão de Medicina, Campo Grande, MS, Brazil
| | - Nicholas E Heiser
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America
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12
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Chaudhary K, Bose N, Tanna D, Chandnani A. Ultrasound-guided pericapsular nerve group (PENG) block versus femoral nerve block for positioning during spinal anaesthesia in proximal femur fractures: A randomised comparative study. Indian J Anaesth 2023; 67:913-919. [PMID: 38044928 PMCID: PMC10691599 DOI: 10.4103/ija.ija_553_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims Femoral nerve block is a widely used analgesia technique for positioning before spinal anaesthesia for proximal femur fracture surgeries. Pericapsular nerve group (PENG) block is a newer technique with motor-sparing characteristics. We compared the analgesic efficacy of these blocks for patient positioning for spinal anaesthesia. Methods In this study, 60 patients were randomised to either the PENG group (n = 30) or the femoral group (n = 30). After performing the block, the pain was assessed every 10 min using a visual analogue scale (VAS) score for 30 min. The primary objective was the median [interquartile range (IQR)] reduction in pain (dynamic VAS with 15-degree passive limb elevation) at 30 min. Secondary objectives were ease of spinal position score (EOSP), angle obtained during positioning, duration of postoperative analgesia and quadriceps weakness. Results The demographics were comparable in both groups. After 30 min, the median (IQR) VAS was 6 (5-7) in the PENG group and 5 (5-6) in the femoral group (P = 0.004). Secondary outcomes such as EOSP score and angle obtained by patients were comparable. In the postoperative period, patients had significantly lower pain in the PENG group compared to the femoral group. The duration of analgesia was prolonged with PENG block. Quadriceps weakness was significantly low with PENG block (P < 0.001). Conclusion PENG block provides better analgesia than a femoral block before spinal anaesthesia for proximal femur fracture surgery. The postoperative duration of analgesia was also longer.
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Affiliation(s)
- Kinjal Chaudhary
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Neeta Bose
- Department of Emergency Medicine, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Dhara Tanna
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
| | - Anup Chandnani
- Department of Anaesthesia, GMERS Gotri Medical College, Vadodara, Gurajat, India
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13
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Lopez-Lopez D, Casas-Reza P, Vilar-Castro A, Sampayo-Rodriguez L. Spinal fentanyl for primary total hip arthroplasty: A double-edged sword? A clinical audit data analysis. Indian J Anaesth 2023; 67:467-470. [PMID: 37333695 PMCID: PMC10269988 DOI: 10.4103/ija.ija_866_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- David Lopez-Lopez
- Department of Anesthesiology, Postoperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - Pablo Casas-Reza
- Department of Anesthesiology, Postoperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - Anxo Vilar-Castro
- Department of Anesthesiology, Postoperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - Lucia Sampayo-Rodriguez
- Department of Anesthesiology, Postoperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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14
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Vamshi C, Sinha C, Kumar A, Kumar A, Kumari P, Kumar A, Kumar S, Arun SK. Comparison of the efficacy of pericapsular nerve group block (PENG) block versus suprainguinal fascia iliaca block (SFIB) in total hip arthroplasty: A randomized control trial. Indian J Anaesth 2023; 67:364-369. [PMID: 37303868 PMCID: PMC10248898 DOI: 10.4103/ija.ija_311_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background and Aims Hip replacement surgery is a commonly performed surgery with the aim of improving mobility in patients suffering from hip conditions. Though the modified suprainguinal approach of fascia iliaca block (SFIB) is commonly used, the analgesic efficacy is moderate and is associated with quadriceps weakness. The pericapsular nerve group (PENG) block has been used to block the sensory articular branches of the hip joint in various hip surgeries. This study aimed to compare SFIB with PENG block in terms of pain relief, opioid consumption and their adverse effects in patients undergoing primary total hip arthroplasties. (THA). Methods Seventy ASA I/II patients undergoing primary THA were enrolled in this double-blinded, randomized trial. Patients were randomly allocated to one of the two groups: Group P: ultrasound (US)-guided PENG block and Group S: patients received the US-guided SFIB. Results Postoperatively, there was statistically significant difference in numerical rating scale (NRS) scores at all-time intervals. Total morphine consumption in 24 hours and 48 hours was statistically more in SFIB group. Five patients had quadriceps weakness in the SFIB group. There was no difference in any other adverse effects. Conclusion US-guided PENG block significantly reduces perioperative morphine consumption and pain scores in THA patients when compared to SFI block. It is not associated with quadriceps weakness as seen in SFIB.
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Affiliation(s)
- Chethan Vamshi
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Chandni Sinha
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Ajeet Kumar
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Abhyuday Kumar
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Poonam Kumari
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency, AIIMS, Patna, Bihar, India
| | - Sudeep Kumar
- Department of Orthopedic Surgery, AIIMS, Patna, Bihar, India
| | - SK Arun
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
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15
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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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16
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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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17
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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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19
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Fahey A, Cripps E, Ng A, Sweeny A, Snelling PJ. Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study. Emerg Med Australas 2022; 34:884-891. [PMID: 35701386 PMCID: PMC9796647 DOI: 10.1111/1742-6723.14013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The pericapsular nerve group (PENG) block was first described for analgesia of hip fracture in 2018. We hypothesised that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the ED. METHODS This was an observational study of routine care. Consecutive patients receiving regional anaesthesia for hip fracture at a single ED were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 min after administration. Maximal reduction in pain scores within 60 min were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 h after regional anaesthesia and adverse events over the duration of admission. RESULTS There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 fascia iliaca compartment blocks, 14 femoral nerve blocks) and 19 received a PENG block. Inexperienced providers were able to successfully perform the PENG block. There was no difference in maximum pain score reduction between the groups. There was no difference in adverse effects between groups. Opioid use was similar between the groups. More patients were opioid-free after a PENG block. CONCLUSIONS The present study demonstrated that the PENG block can be provided safely and effectively to patients with hip fracture in the ED. On the basis of this pilot study, a larger randomised controlled study should now be designed.
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Affiliation(s)
- Alan Fahey
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia
| | - Elinor Cripps
- Department of AnaesthesiaLismore Base HospitalLismoreNew South WalesAustralia
| | - Aloysius Ng
- Department of Acute Care MedicineFiona Stanley HospitalPerthWestern AustraliaAustralia
| | - Amy Sweeny
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and Medicine, Bond UniversityGold CoastQueenslandAustralia
| | - Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Sonography Innovation and Research GroupGold CoastQueenslandAustralia,Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
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Ahiskalioglu A, Yayik AM, Celik EC, Enes Aydin M, Ciftci B, Oral Ahiskalioglu E, Bilal B, Narayanan M, Tulgar S. The Shining Star of the Last Decade in Regional Anesthesia Part-I: Interfascial Plane Blocks for Breast, Thoracic, and Orthopedic Surgery. Eurasian J Med 2022; 54:97-105. [PMID: 36655452 PMCID: PMC11163362 DOI: 10.5152/eurasianjmed.2022.22321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/09/2022] [Indexed: 01/19/2023] Open
Abstract
Regional anesthesia has benefits beyond just treating acute postoperative pain. Interfascial plane blocks, which have been very popular with ultrasound in recent years, function primarily by administering a high volume of a local anesthetic to the fascial plane. Contrary to traditional peripheral nerve blocks, the targeted nerve or structure in interfacial plane blocks is not fully defined, and the indications have not been fully revealed yet. Anatomical, cadaveric, and radiological studies show how effective the interfascial plane blocks play a role. This review focuses on the benefits, techniques, indications, and complications of interfascial plane blocks in the context of breast, thoracic, and orthopedic surgery.
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Affiliation(s)
- Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Murat Yayik
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Erkan Cem Celik
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Muhammed Enes Aydin
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Bahadir Ciftci
- Department of Anaesthesiology and Reanimation, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Elif Oral Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Bora Bilal
- Department of Anesthesia and Reanimation, Kahramanmaras Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Madan Narayanan
- Department of Anaesthesia, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun, Turkey
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Malik A, Thom S, Haber B, Sarani N, Ottenhoff J, Jackson B, Rance L, Ehrman R. Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED.
Recent Findings
The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized.
Summary
Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.
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22
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Kalashetty MB, Channappagoudar R, Alwandikar V, Naik DL, Hulakund SY, Guddad A. Comparison of Pericapsular Nerve Group Block with Fascia Iliaca Compartment Block in Adult Patients Undergoing Hip Surgeries: A Double-Blinded Randomized Control Study. Anesth Essays Res 2022; 16:397-401. [PMID: 36620112 PMCID: PMC9813981 DOI: 10.4103/aer.aer_123_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background Hip fractures are the most common orthopedic condition in elderly patients. In this patient group, efficient preoperative analgesia that reduces the requirement for opioids and their negative side effects is crucial. This study aims for evaluating the efficiency of fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) in providing the appropriate analgesia before positioning patients for spinal anesthesia (SA). Methods Ninety participants undergoing hip surgeries under SA were selected randomly to receive PENG block (n = 45) using 20 mL 0.25% bupivacaine or FICB using 30 mL of 0.25% bupivacaine. The blinded observer assessed Visual Analog Scale (VAS) scores at rest, with passive leg raise to 15° before and after 30 min of the block. The blinded observer also recorded hemodynamic parameters including noninvasive blood pressure respiratory rate and heart rate. The data were analyzed using SPSS version 19. Using the appropriate statistical methodology, continuous and categorical data were analyzed, and P ≤ 0.05 was considered statistically significant. Results At rest and with a passive leg raise to 15°, VAS scores in the PENG and FICB groups decreased significantly (P < 0.0001). After 30 minutes of performing the PENG block, the VAS scores at rest and passive leg raise were 2.16±0.67 and 3.29±0.73 respectively, whereas with the fascia iliaca block the VAS scores at rest and passive leg raise were 4.07±0.69 and 5.11±0.71 with the p = 0.001, which is highly significant. Conclusion PENG block outperforms fascia iliaca block in providing effective analgesia before positioning patients undergoing hip surgery under SA.
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Affiliation(s)
| | | | | | - Dinesh L. Naik
- Department of Anaesthesiology, S N Medical College, Bagalkote, Karnataka, India
| | - S. Y. Hulakund
- Department of Anaesthesiology, S N Medical College, Bagalkote, Karnataka, India
| | - Aishwarya Guddad
- Department of Anaesthesiology, S N Medical College, Bagalkote, Karnataka, India
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23
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Sharma N, Bansal K, Singh M, Sharma A, Roy R, Sethi S. Comparison of suprainguinal approach with infrainguinal approach of fascia iliaca compartment block for postoperative analgesia. Indian J Anaesth 2022; 66:S294-S299. [DOI: 10.4103/ija.ija_823_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
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