Continuous pericapsular nerve group block for postoperative pain management in total hip arthroplasty: report of two cases

Abstract

Background Total hip arthroplasty (THA) is one of the surgical procedures associated with severe postoperative pain. Appropriate postoperative pain management is effective for promoting early ambulation and reducing the length of hospital stay. Effects of conventional pain management strategies, such as femoral nerve block and fascia iliaca block, are inadequate in some cases. Case presentation THA was planned for 2 patients with osteoarthritis. In addition to general anesthesia, continuous pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block were performed for postoperative pain management. Numerical rating scale (NRS) scores measured at rest and upon movement were low at 2, 12, 24, and 48 h postoperatively, suggesting that the treatments were effective for managing postoperative pain. The Bromage score at postoperative days (POD) 1 and 2 was 0. Conclusion Continuous PENG block and LFCN block were effective for postoperative pain management in patients who underwent THA. PENG block did not cause postoperative motor blockade.

Does Preoperative Vitamin D Level Effect Acute Postoperative Pain After Hip Arthroplasty Surgery

“…Hip arthroplasty is associated with high degree postoperative pain. Effective postoperative pain management leads to early recovery and reduces hospital stay (21,22). In our study, it was found that there was a negative correlation between the vitamin D values of our patients and the postoperative VAS scores at the 1st, 2nd, 6th, 8th, and 24th hours, and the VAS score increased as the vitamin D level decreased.…”

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

“…Among clinical studies utilizing PENG block ( n = 29), most are low-quality case reports/series [ 1 , 2 , 3 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], but one cohort study [ 59 ] and eight randomized controlled trials [ 4 , 5 , 60 , 61 , 62 , 63 , 64 , 65 ] appeared in the literature after late 2020. Definite post-procedural quadriceps weakness after PENG block was reported in two case reports [ 2 , 3 ] and two RCTs [ 4 , 5 ] (group A).…”

“…Among PENG block studies that reported no post-procedural quadriceps weakness or made no mention of motor function at all, clinical manifestations of extra-IP spread of local anesthetics either as observed injectate spread to the FIC in ultrasound images [ 42 ], sensory loss of dermatomes corresponding to the femoral nerve [ 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ], or an absence of statistically significant difference in quadriceps strength in patients receiving a supra-inguinal fascia iliaca compartment block (SI-FICB) [ 60 , 61 ] were found in nine case reports/series [ 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ] and two RCTs [ 60 , 61 ] (group B). Nine case reports/series [ 1 , 48 , 52 , 54 , 55 , 56 , 57 , 64 , 66 ], one cohort study [ 60 ], and four RCTs [ 62 , 63 , 64 , 65 ] using PENG block specifically reported no motor block at all (group C).…”

“…Based on the injectate spread behavior observed in IPB ( Figure 4 ), we then produced a model of injectate spread behavior after PENG block ( Figure 7 ) according to the deduced routes of spread from the currently available PENG block clinical studies ( Table 1 ). After PENG block, the most frequently observed route of spread was medial fascial plane (bursal) spread [ 1 , 2 , 5 , 42 , 48 , 52 , 57 , 58 , 60 , 62 , 64 , 65 ], followed by lateral fascial plane spread [ 42 , 52 , 55 , 57 ] and superficial intramuscular spread of the iliopsoas complex [ 2 ] ( Table 1 ). Note that the frequency of superficial intramuscular spread is very likely to be underestimated since its occurrence could not be readily distinguished from the static images provided by these studies.…”