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

Zheng, Jianqiao; Du, Li; Chen, Guo; Zhang, Lu; Deng, Xiaoqian; Zhang, Weiyi

doi:10.1136/bmjopen-2022-065304

Cited by 3 publications

(1 citation statement)

References 122 publications

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“…Reports indicate that inadequate management of postoperative pain is associated with various surgical, autonomic, and metabolic complications, as well as higher incidences of patient complaints ( 2 , 20 ). Although nonsteroidal anti-inflammatory drugs (NSAIDs) serve as an effective analgesic in the perioperative context and play a pivotal role in multimodal analgesia, their use in patients undergoing spinal surgery carries risks such as bone nonunion and postoperative bleeding ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial

Mahmoud,

Alsaied,

Ragab

et al. 2024

Anesth Pain Med

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Background: Postoperative pain management is crucial for improving patient outcomes following posterior cervical spine surgery. Opioids are effective but carry a risk of respiratory depression. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used but may not provide adequate pain relief and have potential complications. The inter-semispinalis plane (ISPB) block is a novel technique for postoperative analgesia in cervical spine surgery. Objectives: This study aims to evaluate and compare the efficacy of the ISPB with general anesthesia in terms of analgesia, postoperative Visual Analog Scale (VAS) pain scores, patient-surgeon satisfaction levels, and the occurrence of postoperative complications. Methods: This double-blind, randomized controlled trial was blinded to both the patient and the assessor. Fifty adult patients (18 - 60 years old) undergoing elective posterior cervical spine surgery were enrolled. The participants were divided into 2 groups: The ISPB group (receiving bilateral ultrasound-guided ISPB at the C5 level) and the control group (receiving general anesthesia only), with each group comprising 25 patients. The study assessed intraoperative fentanyl use, postoperative VAS pain levels, the need for rescue analgesia, and complications. Results: The ISPB group showed significantly lower intraoperative fentanyl consumption (median 100 vs. 100 - 150 μg, P = 0.022) and lower postoperative pain scores at 1, 8, 12, and 48 hours (P = 0.016, 0.009, 0.005, 0.016). Additionally, the ISPB group required less postoperative pethidine (20% vs. 64%, P = 0.002) and had a longer delay before requesting pethidine (hazard ratio 0.215, P = 0.001). Surgeon satisfaction was significantly higher in the ISPB group (P = 0.003). These results suggest that the ISPB can effectively reduce pain and analgesic requirements. Conclusions: The ISPB is an effective analgesic technique for posterior cervical spine surgery, reducing opioid consumption, providing better pain control, and enhancing surgeon satisfaction without increasing complications. This approach has the potential to improve postoperative care and patient outcomes in this surgical population.

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Section: Discussionmentioning

confidence: 99%

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial

Mahmoud,

Alsaied,

Ragab

et al. 2024

Anesth Pain Med

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Rapid recovery after total hip arthroplasty: direct anterior approach combined with PENG block and lateral cutaneous femoral nerve block

Eremin,

Daniliyants,

Ermakova

et al. 2024

jour

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Introduction The "gold" standard for the treatment of late stages of coxarthrosis is total hip arthroplasty. Direct anterior approach (DAA) refers to minimally invasive surgical interventions in orthopaedics. Extended anesthetic measures in combination with low-traumatic surgical techniques may reduce postoperative pain and accelerate patient's recovery.The purpose of the study was to compare the recovery times of patients after hip arthroplasty using DAA in combination with PENG block, lateral cutaneous femoral nerve (LCFN) block and without extended anesthetic measures.Materials and methods A prospective randomized comparative clinical study was performed, which involved 62 patients divided into two groups: the study one (n = 29) and the control one (n = 33). In both groups, arthroplasty was performed using DAA. Patients of the study group underwent PENG block and LCFN block. The patients in the control group did not receive extended anesthesia. The evaluation criteria were pain assessment using the visual analogue scale (VAS), administration of painkillers, patient’s mobility and the length of hospital stay.Results The VAS score for pain in the study group were lower than in the control group after 6 hours — 3.7 (3.4; 4.1) and 4.3 (4.2; 4.8); 24 hours after surgery — 3.5 (3.3; 3.6) and 4.1 (3.9; 4.5) (p < 0.001). After 48 hours, the indices were comparable: 3.5 (3.1; 4.1) and 3.7 (3.6; 3.9) (p = 0.19). The rate of requests for pain relief in the first 24 hours was lower in the study group than in the control group: 2 (1; 2) and 3 (2; 3) cases (p = 0.003). The results of the manual muscle test after 6 hours and 24 hours were comparable (p > 0.05). The time interval between the end of the operation and the first walking on crutches was shorter in the study group — 3.1 hours (2.9; 3.4) and 3.98 hours (3.8; 4.2) (p < 0.001). The length of hospital stay was shorter in the study group: 1.5 (1.2; 2) and 2.5 (2; 3) days (p < 0.001).Discussion Lower postoperative pain allows faster activation of patients, thus improving the results of the early rehabilitation period.Conclusion The use of PENG block and LCFN block in arthroplasty with the use of DAA has clinical effectiveness in the first 24 hours, and helps to accelerate the postoperative recovery of patients.

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Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research

Niyonkuru,

Iqbal,

Zeng

et al. 2024

JPR

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Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate the exploration of alternatives. This narrative review highlights the potential of nerve blocks as a safe and effective strategy for post-surgical pain control. This review explores the use of various nerve block techniques tailored to specific surgical procedures. These include nerve blocks for abdominal surgeries; fascial plane blocks for chest surgeries; nerve blocks for arm surgeries; and nerve blocks for lower limb surgery including; femoral, hip, and knee surgeries. By targeting specific nerves, these blocks can provide targeted pain relief without the negative side effects associated with opioids. Emerging evidence suggests that nerve blocks can be as effective as opioids in managing pain, while potentially offering additional benefits such as faster recovery, improved patient satisfaction, and reduced reliance on opioids. However, the effectiveness of nerve blocks varies depending on type of surgery, and in individual patients. Rebound pain, which temporary increase in pain after a block wears off, can occur. In addition, some techniques require specialized guidance for accurate placement. In conclusion, nerve blocks show great promise as effective alternatives for managing post-surgical pain. They can reduce the need for opioids and their side effects, leading to better patient outcomes and satisfaction. Future studies should assess the long-term impacts of specific nerve blocks on mortality rates, cost-effectiveness, and their incorporation into multimodal pain management approaches to further enhance post-surgical care.

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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

Cited by 3 publications

References 122 publications

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial

Inter-Semispinalis Plane Block Versus General Anesthesia for Postoperative Analgesia in Posterior Cervical Spine Surgery: A Randomized Controlled Trial

Rapid recovery after total hip arthroplasty: direct anterior approach combined with PENG block and lateral cutaneous femoral nerve block

Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research

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