Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review

Abstract

IntroductionPericapsular nerve group (PENG) block is a novel regional analgesia technique to reduce pain after hip surgery and hip fractures. This review was conducted to summarize current literature.MethodsA scoping review was carried out using the Joanna Briggs Institute framework. All articles describing the use of PENG block as a regional analgesia and/or anesthesia technique for hip pain were considered eligible for inclusion. Ovid Medline, Embase, CINAHL, PubMed and Google Scholar were searched. Adult and pediatric studies were included. Excluded were articles not available in English language, not available in full-text, related to non-orthopedic indications such as soft tissue surgery, and pelvic or femoral shaft fractures.ResultsDatabase searches identified 345 articles, 20 of which could be included in the current review, with a combined patient number of 74. Included articles comprised case reports and case series only, describing 1 to 10 patients. In all studies, PENG block was described to provide sufficient analgesia or anesthesia. Transient motor side effects occurred only when the local anesthetic was deposited in an unintended location (n=2).ConclusionsCurrent evidence of using PENG block for hip surgery or hip pain is limited to case reports and case series only. PENG block is a promising regional analgesia technique as an alternative to other regional nerve blocks such as femoral nerve block or iliac fascia nerve block. Observational and experimental studies are required to determine the effectiveness, efficacy and safety of the PENG block.

Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia

“…Following the initial description of PENG block, there have been a significant number of publications of case reports and case series highlighting the excellent analgesic benefit for perioperative analgesia in hip surgery. [ 3 4 5 14 15 16 26 27 ] The initially suggested technique was an in-plane technique; however, out-of-plane and landmark-based techniques have also been suggested. [ 28 ] Very few studies comparing PENG block with FICB or similar other regional analgesia techniques have been published in the literature.…”

Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

“…Prior to this study, literature supporting the PENG block for hip fractures has been limited. 15 There have been three case series and two case reports, amounting to a total of 22 patients, on the use of PENG block for effective analgesia of hip fractures. 15 Existing comparative literature for the PENG block consists of a single cohort study of a convenience sample of 42 perioperative patients that compared postoperative opioid requirement after PENG block or FNB and demonstrated no difference.…”

“…14 However, existing evidence for use of the PENG block for analgesia of hip fractures is currently limited. 15 The objective of this study was confirm the feasibility of the PENG block in everyday ED practice and to compare the safety and effectiveness of the PENG block against the current standard regional anaesthesia techniques, FICB and FNB, hereafter combined and referred to as femoral blocks (FB), for patients with hip fracture in the ED. We hypothesise that it is safe and effective for emergency medicine clinicians of variable experience to perform the PENG block for patients presenting to ED with a hip fracture.…”

Four Important Blocks of the Last Decade

“…Pericapsular nerve group (PENG) block is a novel regional analgesia technique4. Current evidence as to its efficacy in hip pain is mainly from case reports and case series, where it has been seen to provide sufficient analgesia with minimal reported side effects [11]. PENG block can be considered as an analgesic technique for hip pathologies, that is alternative to lumbar plexus block, femoral nerve block or fascia iliaca blocks, particularly when motor weakness has to be avoided [11].…”