The Pericapsular Nerve Group Block for Perioperative Pain Management for Hip Arthroscopy.
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ABSTRACT:
SUBMITTER: Fernicola
PROVIDER: S-EPMC8322623 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Fractures in and around the hip are common presentations in the emergency department. It is commonly seen in the elderly as a result of osteoporotic changes. However, younger age groups are also affected, especially as a result of high velocity trauma. Irrespective of age, hip fractures are extremely painful, and it is difficult to position the patients for anesthesia procedures. Most of these cases are performed under subarachnoid block (SAB) or combined spinal-epidural anesthesia (CSEA), which requires the patient to be in sitting or lateral position. Here, we report a series of ten cases where pericapsular nerve group (PENG) block was administered prior to positioning the patients for SAB or CSEA. This block is a recently described regional anesthesia technique that provides excellent analgesia for hip fractures. It also provides very good analgesia for patient positioning during procedures such as SAB or CSEA.
| S-EPMC7091518 | biostudies-literature
Project description:ObjectiveThe review aimed to compare outcomes of pericapsular nerve group block (PENG) vs. fascia iliaca compartment block (FICB) for patients undergoing hip surgeries.MethodsRandomized 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.ResultsSix 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.ConclusionModerate 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 registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022350342.
| S-EPMC9953592 | biostudies-literature
Project description:This study compared the effects of the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on postoperative analgesia and quadriceps strength following total hip arthroplasty under general anesthesia. A total of 58 patients were randomized to receive either PENG block (PENG group) or supra-inguinal FICB (FICB group) following anesthetic induction. The primary outcomes were the postoperative pain scores. Patients were randomized to receive either PENG block or supra-inguinal FICB following anesthetic induction. Pain scores at rest and with movement were assessed preoperatively, at the postanesthesia care unit (only at rest), and at 6, 24, 36, and 48 h postoperatively. Opioid consumption was also assessed for 48 h postoperatively. Quadriceps strength measurements were performed preoperatively, at 6, 24, and 36 h postoperatively. In total, 54 patients completed the study: 27 in the PENG group and 27 in the FICB group. Despite lower pain scores at rest in the PENG group at postoperative 6 and 24 h, there were no significant differences in the pain scores at rest and during movement between the two groups during postoperative 48 h in the linear mixed model analysis (p = 0.079 and p = 0.323, respectively). Cumulative opioid consumption up to postoperative 48 h was also similar in the two groups (p = 0.265). The changes in quadriceps strength measurements in the operative leg and the nonoperative leg were not significantly different between the groups (p = 0.513 and p = 0.523, respectively). The PENG block may have similar analgesic efficacy to the supra-inguinal FICB. No difference was detected in the quadriceps strength between the patients receiving these two blocks.
| S-EPMC8951338 | biostudies-literature
Project description:BackgroundPericapsular nerve group block (PENG) is an emerging regional anesthesia technique for hip surgery. However, its efficacy in total hip arthroplasty (THA) isn't well defined. We perform this meta-analysis aiming to assess the effect of Pericapsular nerve group block on pain control and morphine consumption in patients with total hip arthroplasty.MethodsWe searched four electronic databases (Pubmed, Embase, Cochrane Library, and Web of Science dated from 2018 to October 2023) for published eligible randomized controlled trials (RCTs) comparing PENG with placebo (no block/sham block) after THA. The outcome measurements consisted of pain score, opioid consumption, Time to first opioid, and postoperative complications. All data analyses were performed using STATA 12.0.ResultsFive RCTs comprising 808 participants were included. Our meta-analysis showed that there were significant differences between two groups in terms of pain score in PACU (WMD = - 0.598, 95% CI [- 0.886, - 0.310], P < 0.001), pain score at 6 h (WMD = - 0.614, 95% CI [- 0.835, - 0.392], P < 0.001) and time to first opioid (WMD = 5.214, 95% CI [4.545, 5.883], P < 0.001). However, no significant differences were revealed from the pain score at 24 h after THA (WMD = - 0.924, 95% CI [- 1.929, 0.081], P = 0.072). Meanwhile, the meta-analysis indicated that PENG significantly reduced 24-h opioid consumption (WMD = - 6.168, 95% CI [- 6.667, - 5.668], P < 0.001) and 48-h opioid consumption (WMD = - 7.171, 95% CI [- 8.994, - 5.348], P < 0.001).ConclusionPericapsular nerve group block was effective for pain control up to postoperative 6 h and extending the time to the first opioid after THA. Moreover, it reduced postoperative opioid consumption when compared with a placebo group. Due to the high heterogeneity of the pain score after 24 h and the low-quality evidence, more high-quality RCTs are required to draw a definitive conclusion about pain control.
| S-EPMC11000340 | biostudies-literature
Project description:The pericapsular nerve group (PENG) block targets the nerves innervating the anterior hip surface; however, few studies on this technique are currently available. We investigated the effects of the PENG block on postoperative opioid consumption after a hip surgery. This was a randomized, double-blind, placebo-controlled study conducted at a single institution. Fifty patients undergoing hip surgery were randomly allocated, 25 in each group, to receive a PENG block either using 25 mL of 0.5% ropivacaine (PENG group) or 25 mL of saline (control group). The primary outcome was the total opioid consumption 24 h postoperatively. The secondary outcomes were postoperative pain scores, time to first opioid demand, sensory block efficiency, quadriceps muscle strength, complications, and patient satisfaction. Compared with those in the control group, patients in the PENG group had a significantly lower total opioid consumption 24 h postoperatively (440.72 ± 242.20 μg vs. 611.07 ± 313.89 μg, P = 0.037) and significantly lower pain scores at 30 min postblock and 6 postoperatively (P < 0.001 and P < 0.001, respectively). The time to first opioid demand was significantly shorter in the control group than in the PENG group (P < 0.001). Sensory block effectiveness was better in the PENG group 30 min postblock and 6 and 12 h postoperatively than in the control group. Patient satisfaction was also better in the PENG group than in the control group. There were no differences in the other outcomes. The PENG block reduced the total opioid consumption in the first 24 h after hip surgery with no significant effects on quadriceps muscle strength and complication rate. This study was registered at the Korea Clinical Research Information Service (cris.nih.go.kr; Reg. No. KCT0006348) on July 16, 2021.
| S-EPMC9780006 | biostudies-literature
Project description:BackgroundMost patients with hip fractures are elderly patients with comorbidities, and well-managed pain management is associated with positive postoperative outcomes. In recent years, new indications for regional anesthesia techniques have been defined, and they have found more place in clinical practice. Herein we investigate the effect of US-guided PENG block on positioning pain and compare that effect to intravenous opioid in patients undergoing surgery under spinal anesthesia for hip fractures. Additionally, we sought to investigate the effect of PENG block on pain scores, opioid intake, time to first analgesic requirement, and quality of recovery within the first 24 h following surgery.MethodsIn this study, patients were divided into the PENG (n = 42) and control group (n = 42) one hour prior to surgery. A team who was blinded to the assigned groups, collected and evaluated all data such as spinal anesthesia positioning pain, postoperative pain, opioid requirement.ResultsPatients that underwent PENG had statistically significantly lower NRS scores after interventions, immediately before positioning, at positioning and at end of spinal anesthesia. Pain scores during positioning for spinal anesthesia were statistically significantly lower in the PENG group than in the control group (p < 0.001). Total morphine use over the first 24 h was extremely statistically significantly lower in the PENG group (p < 0.001).ConclusionsPositive outcomes of PENG block in patient positioning pain before spinal anesthesia, postoperative pain scores, and morphine consumption are consistent with similar studies. High patient satisfaction in patients who underwent PENG block contributes to the literature.Trial registrationClinicalTrials.gov Identifier: NCT04871061.
| S-EPMC10503118 | biostudies-literature
Project description:BackgroundPerioperative pain management strategies in the elderly undergoing hip arthroplasty need special and safe preemptive care.ObjectivesThe primary aim of this study was to compare the analgesic effects of preemptive ultrasound-guided pericapsular nerve group (PENG) block and lumbar erector spinae plane block (L-ESPB) in the elderly undergoing hip arthroplasty. The time to the first postoperative rescue analgesia was measured. The secondary aim was to assess the ease of spinal positioning (EOSP), onset of sensory block, block performance time, and patient satisfaction.MethodsBefore positioning for spinal anesthesia, 69 elderly patients undergoing hip arthroplasty were randomized into three groups (n = 23 per group). The first intervention group received ultrasound-guided PENG block with 20 mL bupivacaine 0.25%; the second intervention group received ultrasound-guided L-ESPB using the same dose of bupivacaine. In the control group, patients received spinal anesthesia without any block.ResultsThe time to first postoperative rescue analgesic (morphine) was significantly prolonged in the PENG group (13.3 ± 3.5 h) compared to the L-ESPB (9.5 ± 2.3 h) and control (2.6 ± 0.4 h) groups. The EOSP score was significantly higher in the PENG group compared to the L-ESPB and control groups (P < 0.001). The block performance time and oneset of the sensory block were significantly shorter in the PENG group compared to the L-ESPB group. The highest patient satisfaction scores were observed in the PENG group.ConclusionsPreemptive pericapsular nerve group block postponed the need for postoperative analgesia and eased spinal positioning compared to L-ESPB in the elderly undergoing hip arthroplasty.
| S-EPMC10664163 | biostudies-literature
Project description:BackgroundThe 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.MethodsThis 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.ResultsPatients 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.ConclusionsCompared 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).
| S-EPMC10666449 | biostudies-literature
Project description:BackgroundThe pericapsular nerve group (PENG) block, quadratus lumborum block (QLB), and intra-articular (IA) local anesthetic injection have been shown to provide effective analgesia in total hip arthroplasty (THA). This randomized study aimed to compare the analgesic efficacy, motor protection, and quality of recovery associated with the PENG block, QLB, and IA injection.MethodsEighty-nine patients who underwent a unilateral primary THA under spinal anesthesia were randomly assigned to the PENG (n=30), QLB (n=30), or IA (n=29) group. The primary outcome was the numerical rating scale (NRS) score over the first 48 h postoperatively. The secondary outcomes were postoperative opioid consumption, quadriceps and adductor muscle strength, and quality of recovery (QoR-40).ResultsThe dynamic (with movement) NRS scores at 3 and 6 h postoperatively were significantly lower in the PENG and QLB groups compared to the IA group (P = 0.002 and P < 0.001, respectively). The time to first opioid analgesia requirement was longer in the PENG and QLB groups than in the IA group (P = 0.009 and P = 0.016, respectively). A provided better preservation was found in the the PENG group than in the QLB group in terms of quadriceps muscle strength at 3 h postoperatively (P = 0.007) and time to mobilization (P = 0.003). No significant differences in the QoR-40 scores were seen.ConclusionsThe PENG and QLB groups showed similar analgesic effects and both showed more effective analgesia 6 h postoperatively than the IA group. All the groups showed similar postoperative quality of recovery.
| S-EPMC10718628 | biostudies-literature
Project description:Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons' responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.
| S-EPMC8081420 | biostudies-literature