Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis

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.

Motor-sparing peripheral nerve blocks for hip and knee surgery

“…Although studies have focused more on postoperative pain outcomes and less on strength, the PENG block has continued to gain in popularity as authors compare it with fascia iliaca compartment block (FICB). A double-blind RCT demonstrated reduced pain scores 12 h postoperatively when comparing the PENG block to FICB in the setting of hip fracture [25 ▪ ]. A meta-analysis by Farag et al [26] comparing PENG to FICB showed a statistically significant difference in pain scores 30 min after surgery but no significant difference after 6 h. Unfortunately, in this study, data regarding quadriceps muscle blockade was not analyzed given that both quantitative and qualitative scales were used differently across studies.…”

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

“…This also can be advantageous in terms of limiting the volume of local anaesthetics to avoid any undesirable effects and preservation of motor function. The decreased opioid consumption was demonstrated only up to 24 hours after receiving the PENG block as suggested by Farag et al which led them to conclude that the analgesic effect post-PENG block wears off after 24 hours [ 29 ]. This may be overcome by adding SIFICB to the PENG block which ultimately becomes helpful to improve the outcome of patients after hip surgery.…”

Regional anesthesia for the geriatric patient: a narrative review and update on hip fracture repair

“…While PENG can blunt most sensory input from the anterior hip capsule, cutaneous coverage may have to be supplemented with LFCN or local subcutaneous infiltration for skin incision. Although PENG primarily targets anterior sensory coverage as evident in anterior or superficial surgical approaches, such as screw/pinning fixation for fractures and anterior THA, it also appears to impact positively on dynamic postoperative pain or pain on motion for a variety of posterior surgical approaches, such as hemiarthroplasties for fractures and posterior THA, as highlighted in several subsequent studies 27,28 . Systematic reviews and meta-analysis have found that PENG can provide better analgesia for a variety of hip surgeries and lower opioid consumption compared with established PNBs such as FNB or FIB 27,28 .…”

“…Although PENG primarily targets anterior sensory coverage as evident in anterior or superficial surgical approaches, such as screw/pinning fixation for fractures and anterior THA, it also appears to impact positively on dynamic postoperative pain or pain on motion for a variety of posterior surgical approaches, such as hemiarthroplasties for fractures and posterior THA, as highlighted in several subsequent studies 27,28 . Systematic reviews and meta-analysis have found that PENG can provide better analgesia for a variety of hip surgeries and lower opioid consumption compared with established PNBs such as FNB or FIB 27,28 . Furthermore, patients receiving PENG had higher postoperative satisfaction levels and less of a motor block compared with other cohorts 28 .…”

“…27,28 Systematic reviews and meta-analysis have found that PENG can provide better analgesia for a variety of hip surgeries and lower opioid consumption compared with established PNBs such as FNB or FIB. 27,28 Furthermore, patients receiving PENG had higher postoperative satisfaction levels and less of a motor block compared with other cohorts. 28 However, the number of RCTs analyzed is minimal, with a limited sample size leading to high degrees of imprecision.…”