Pericapsular Nerve Group (PENG) Block in Combination With the Quadratus Lumborum Block Analgesia for Revision Total Hip Arthroplasty: A Retrospective Case Series

Kukreja, Promil; Schuster, Braden; Northern, Theresa; Sipe, Sandra; Naranje, Sameer; Kalagara, Hari

doi:10.7759/cureus.12233

Cited by 12 publications

(12 citation statements)

References 18 publications

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“…Kukreja et al [18] reported mild postoperative pain scores in a retrospective case series of patients undergoing hip arthroplasty, while Mysore et al [17] found that the PENG block was associated with a 2.4 mg reduction in 24-h hydromorphone consumption among patients receiving local infiltration analgesia following total hip arthroplasty, although average pain scores were comparable. Moreover, PENG block has been successfully used with other techniques to manage total hip arthroplasty analgesia, that is, quadratus lumborum block [14], lumbar erector spinae block [23] and lateral femoral cutaneous nerve block as described by Thallaj [24] The rationale for the addition of the lateral femoral cutaneous nerve block is that PENG block only covers peripheral fibres innervating anterior hip capsule, omitting analgesia for skin incision. However, as described by Nielsen et al, lateral femoral cutaneous nerve block covers only part of the surgical wound in total hip arthroplasty, as most of the surgical incision is innervated by lateral cutaneous branches of the iliohypogastric and subcostal nerves [25].…”

Section: Discussionmentioning

confidence: 99%

“…The pericapsular nerve group (PENG) block is an ultrasound-guided approach, first described by Giron-Arango et al for the blockade of the articular branches of the femoral, obturator and accessory obturator nerves that provide sensory innervation to the anterior hip capsule [9,10]. It has been successfully used as an alternative regional anaesthesia technique for the management of acute pain after hip fracture [11,12], but its applications are expanding, suggesting a potential role for analgesia after elective hip surgery [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

et al. 2021

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The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently lacking. In this single-centre, observer-masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0-10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time-points, with a median (IQR [range]) of 2.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

et al. 2021

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“…In addition, it has a motor-sparing effect which is achieved by targeting only the sensory articular branches of the femoral nerve (FN) and accessory obturator nerve [ 14 ]. Applications of the technique are expanding; it was recently used not only as an alternative regional anesthesia technique for acute pain in hip fracture patients but also for analgesia after elective hip surgeries [ 30 , 31 ]. Recent case reports used the technique for other anesthetic purposes beyond the hip joint capsule such as vein ligation and stripping [ 32 ]; however, it was highly criticized and described as “undesired effect” by Girón-Arango et al [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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

Farag

Diab

2022

J Anesth

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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.

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“…The combination of PENG block and local anaesthetic infiltration (LIA) or PENG and lumbar erector spinae plane (LESP) block for postoperative pain after hip surgery has been used successfully (Ince et al, 2020 ; Fusco et al, 2019 ; Sandri et al, 2020 ; Ince & Kilicaslan, 2020 ). LFCN and PENG block and PENG and QL have also been successfully used in combination in hip surgery (Casas Reza et al, 2020 ; Kukreja et al, 2020a , b ). In fact, the combination of PENG, FIB, and FN block has been reported to provide efficient analgesia while using 0.25% bupivacaine with a total of 70 (20 + 30 + 20) ml (Koyuncu et al, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Being a primary sensory block, it may facilitate early mobilization and recovery, unlike other nerve blocks (Luftig et al, 2020 ; Yu et al, 2019 ; Pagano et al, 2019 ). Authors believe it to be comparatively safer in patients with comorbidity (Ahiskalioglu et al, 2020a ; Dangle et al, 2020 ; Fusco et al, 2020a , b ; Kukreja et al, 2020a , b ). It has been pointed out not to consider it as a safe block in patients on anticoagulants in general, and its use in appropriate clinical context has been urged (Black & Chin, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

Pericapsular nervegroup (PENG) block—a scoping review

Kaur

Saikia

Dey

et al. 2022

Ain-Shams J Anesthesiol

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The obturator nerve and its accessory branch supplying the hip region, unlike the femoral nerve, are not adequately anaesthetized by conventional regional anaesthetic techniques targeting the hip region. With advancements in ultrasound-guided regional anaesthetic techniques, interests are revived in the field and efforts are being made to block them together. One such successful attempt is the novel peri-capsular nerve group (PENG) block. Consequently, further research on the PENG block began to explore its versatilities. The present study undertakes a scoping review of research on the PENG block in humans for any indication to determine the extent of the research done, the methodologies used, and other practical issues addressed in the research. This will help to identify potential research gaps that should be addressed in the future. PubMed, Google Scholar, Cochrane Library, KoreaMed, Latin American and Caribbean Health Science Literature, and the directory of open access journals were searched with the keyword “PENG block” and “pericapsular nerve group”. Manual search of electronically retrieved papers was also carried out. Among the 67 articles selected in our review, eighteen are case series; twenty-nine are case reports; two are randomized studies; one each of prospective cohort study, review, and cadaveric study; and 15 are editorials. However, only 64 articles were included later due to the retraction of three case reports. Data is insufficient to provide firm recommendations for or against different aspects of the block. The review encourages future work addressing different aspects of the PENG block.

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Pericapsular Nerve Group (PENG) Block in Combination With the Quadratus Lumborum Block Analgesia for Revision Total Hip Arthroplasty: A Retrospective Case Series

Cited by 12 publications

References 18 publications

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

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

Pericapsular nervegroup (PENG) block—a scoping review

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