Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial

Hu, Jian; Wang, Qiuru; Hu, J. F.; Kang, Pengde; Yang, Jing

doi:10.1016/j.arth.2022.12.023

Cited by 21 publications

(40 citation statements)

References 35 publications

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“…The characteristics and outcomes of the included studies are shown in Table 1. The 12 RCTs involved 705 patients 23,[31][32][33][34][35][36][37][38][39][40][41] of whom 351 (49.8%) received PENG block, and 354 (50.2%) did not. Of those without PENG, 106 received no block, 23,34,41 111 received a sham block with saline, 31,33,39 81 received FIB, 32,35,36,38 and 56 received periarticular infiltration.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The 12 RCTs involved 705 patients 23,[31][32][33][34][35][36][37][38][39][40][41] of whom 351 (49.8%) received PENG block, and 354 (50.2%) did not. Of those without PENG, 106 received no block, 23,34,41 111 received a sham block with saline, 31,33,39 81 received FIB, 32,35,36,38 and 56 received periarticular infiltration. 37,40 Out of the 106 patients who received no block, 23,34,41 20 received intravenous (IV) opioids as a control.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…34 Two studies administered periarticular infiltration in both groups, in which 64 of them were in the PENG block group. 23,31 A total of 234 (33.2%) patients received general anesthesia 31,33,36,38,39 while the remaining patients received spinal anesthesia as a primary anesthetic. 23,[32][33][34][35]37,40,41 In 5 studies, the peripheral nerve block was placed before the induction of general 31,39 or spinal anesthesia.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…23,31 A total of 234 (33.2%) patients received general anesthesia 31,33,36,38,39 while the remaining patients received spinal anesthesia as a primary anesthetic. 23,[32][33][34][35]37,40,41 In 5 studies, the peripheral nerve block was placed before the induction of general 31,39 or spinal anesthesia. 34,35,41 In 4 RCTs, blocks were placed after general 36 or spinal anesthesia, 23,33,37 but before surgical incision.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty - A Systematic Review and Meta-analysis

Pai,

Amor,

Lai

et al. 2024

The Clinical Journal of Pain

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Background: Ultrasound-guided pericapsular nerve group (PENG) block is an emerging regional anesthesia technique that may provide analgesia for patients undergoing total hip arthroplasties (THA). There are clinical studies comparing this fascial plane block to other established methods, however, evidence on the actual efficacy of this block for THA continues to evolve. Objective: Available clinical studies conducted over the past 4 years, were reviewed to evaluate the analgesic efficacy and effectiveness of PENG block in patients undergoing THAs. Methods: A meta-analysis of randomized controlled trials (RCTs) in patients undergoing THA, where PENG block was compared to no block, placebo/sham block (injection with saline), or other analgesic techniques including suprainguinal fascia iliaca block (FIB), or periarticular infiltration (PAI) was performed. Our primary outcome was opioid consumption during the first 24 hours. Secondary outcomes were postoperative rest and dynamic pain scores at 6-12, 24 and 48 hours, block performance time, sensory motor assessment, quadriceps weakness, incidence of postoperative falls, first analgesic request, block and opioid related complications, surgical complications, patient satisfaction scores, post anesthesia care unit length of stay, hospital length of stay, and functional and quality of life outcomes. Results: We included 12 RCTs with a total of 705 patients. Data showed that PENG block decreased 24-hour oral morphine milligram equivalent consumption by a mean difference (MD) of 3.75 mg (95%CI: -5.96,−1.54; P=0.0009). No statistically significant differences in rest or dynamic pain were found, except for a modest MD reduction in dynamic pain score of 0.55 points (95% CI: −0.98, −0.12; P=0.01), measured 24 hours after surgery in favor of PENG block. Conclusions: Our systematic review and meta-analysis suggest that PENG block provides better analgesia, measured as MME use, in the first 24 hours after THA, with no real impact on postoperative VAS scores. Despite statistical significance, the high heterogeneity across RCTs implies that PENG’s benefits may not surpass the minimal clinically important difference threshold for us to recommend PENG as best practice in THA.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty - A Systematic Review and Meta-analysis

Pai,

Amor,

Lai

et al. 2024

The Clinical Journal of Pain

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“…1). In addition, the PENG block reduces pain scores at rest and movement, reducing analgesic drugs pre-and post surgery [23] and extending the first time to rescue analgesia [27,28]. Research to date suggests that the PENG block should be the primary method of analgesia in Total Hip Arthroplasty due to its potential to impact recovery pathways and contribute to costsaving [22].…”

Section: Peng Vs Placebomentioning

confidence: 99%

The pericapsular nerve group (PENG) block for hip surgery. A narrative review

Reysner¹,

Kowalski²,

Grochowicka³

et al. 2023

Chir Narzadow Ruchu Ortop Pol

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Introduction. Perioperative pain management associated with hip surgery is challenging. The pericapsular nerve group (PENG) block is a new technique thought to provide better postoperative analgesia in addition to its motor-sparing effects. Aim. This review aims to evaluate the safety and efficacy of the PENG blockade in managing postoperative pain in patients undergoing hip surgery. Methods. The literature was reviewed through four electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase. Results. The initial search yielded 416 articles. Twenty-seven relevant articles were selected based on relevance, recentness, search quality, and citations. Twelve of the studies were related to patients undergoing total hip arthroplasty. Twelve studies were related to patients undergoing total hip surgery due to hip fracture. Finally, three studies were related to patients undergoing hip arthroscopy. Conclusions. The PENG block provides superior analgesia and low opioid consumption in the first postoperative period. However, current evidence is insufficient, and there is a need for high-quality randomized, controlled trials with larger sample sizes.

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Impact of previous lumbar spine surgery on total hip arthroplasty and vice versa: How long should we be concerned about mechanical failure?

et al. 2023

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Introduction This registry study aims to assess the prevalence and demographic characteristics of patients with lumbar spine (LS) surgical procedures who undergo total hip arthroplasty (THA), to compare the long-term survival and causes of failure of THA in patients who previously underwent LS fusion and non-fusion surgical procedures, and to evaluate the risk of undergoing a revision LS surgery after THA. Materials and methods Patients who underwent LS surgery followed by THA were identified by cross-referencing data from the Orthopedic Prosthetic Implants Registry and the Regional Hospital Discharge Database. Three groups of THA patients were identified: patients who underwent previous lumbar surgery with fusion (LS fusion-THA), without fusion (LS non-fusion-THA), and a control group with only THA (No LS surgery–THA). Demographic data, THA survival, number and causes of failure, and data on revision procedures on THA and LS were collected. Results Of the total of 79,984 THA, 2.2% of patients had a history of LS procedures. THA only patients showed better results, while patients in the LS fusion-THA group had worse implant survival at 5-year follow-up. In the LS fusion-THA and LS non-fusion-THA, mechanical THA failures were more frequent in the first two years after implantation. There were no differences between groups regarding the risk of undergoing LS revision surgery. Conclusions LS surgery negatively affects THA survivorship. In patients who previously underwent LS fusion and non-fusion surgical procedures, most THA failure occurs in the first two years after implant. The study contributes to the understanding of the relationship between the hip and the LS and provides useful guidance for clinical practice.

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Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial

Cited by 21 publications

References 35 publications

Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty - A Systematic Review and Meta-analysis

Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty - A Systematic Review and Meta-analysis

The pericapsular nerve group (PENG) block for hip surgery. A narrative review

Impact of previous lumbar spine surgery on total hip arthroplasty and vice versa: How long should we be concerned about mechanical failure?

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