Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Andrade, Priscila P.; Lombardi, Rafael A.; Marques, Isabela R.; Braga, Anna Carla Di Napoli Andrade e; Isaias, Beatrice R.S.; Heiser, Nicholas E.

doi:10.1016/j.bjane.2023.07.007

Cited by 3 publications

(1 citation statement)

References 34 publications

(53 reference statements)

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“…Recently, several systematic reviews and meta-analyses comparing PENG block and FICB for hip surgery have revealed somewhat inconsistent results. Andra et al [35] suggested that the PENG block reduces opioid consumption during the initial postoperative 24 h and decreases the pain score at rest at 12 h postoperatively compared to FICB. Another analysis [36] showed no difference in pain scores at 6, 12, and 24 h between PENG and FICB, but the mean opioid consumption in morphine equivalents was significantly lower with PENG compared to FICB.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Yoo,

Lee,

Beak

et al. 2024

Medicina

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Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral incision, affecting the cutaneous supply by branches of the lateral femoral cutaneous nerve (LFCN), the LFCN block can contribute to postoperative analgesia. However, no studies have investigated the effectiveness of supplemental PENG block combined with LFCN block in patients undergoing LIA after hip fracture surgery. Our study aimed to assess the effectiveness of PENG combined with LFCN block following hip fracture surgery in patients who underwent LIA. Materials and Methods: Forty-six patients were randomly assigned to LIA or PENG + LFCN + LIA groups. The primary outcome was the pain score at rest and during movement at 2, 6, 12, 24, and 48 h postoperatively. The total opioid dose for postoperative analgesia was also measured at the same time points. Secondary outcomes included postoperative cognitive function assessment. Results: The median pain scores at rest and during movement were lower in the PENG + LFCN + LIA group throughout the study periods compared to the LIA group, except at 2 h (at rest) and 48 h (during movement) after surgery. The total fentanyl dose was lower in the PENG + LFCN + LIA group at all time points after surgery when compared to the LIA group. Postoperative delirium incidence and the median abbreviated mental test scores were not significantly different between the two groups. Conclusions: The combination of PENG and LFCN blocks may contribute to enhanced recovery for patients undergoing LIA after hip fracture surgery. However, further well-controlled research is necessary to determine the effectiveness of supplemental PENG combined with LFCN block in addressing cognitive deficits in these patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Yoo,

Lee,

Beak

et al. 2024

Medicina

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Pericapsular Nerve Group (PENG) Block on Cadavers: A Scoping Review

Margenfeld,

Zendehdel,

Poilliot

et al. 2024

Journal of Diagnostic Medical Sonography

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Objective: The implementation of sonography has revolutionized anesthesia, especially local anesthesia. High-resolution sonography as an essential, well-established, and versatile technique now makes it possible to perform targeted nerve blocks and therefore to anesthetize with increasing precision. Ultrasonographic (US)-guided nerve blocks on cadavers are often used as pilot studies to investigate new techniques. The aim of this review was to map out US-guided pericapsular nerve group (PENG) block in human cadavers. Materials and Methods: A systematic scoping review following PRISMA-ScR guideline. A systematic literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews, and Web of Science Core Collection. The publishing year was not subject to any extra limitations. Only sonography studies on human cadavers were included. The article was included if the PENG block was the subject of the study. Results: The search found 9821 matches, from which 291 investigated nerves. Four studies investigated the PENG block. A total volume of 2396 ml dye was injected with an average volume of 19.01 ml for each PENG block. 126 US-guided PENG blocks were performed on human cadavers. Conclusion: Based on our assessment, this study is the first review to screen US-guided PENG blocks on human cadavers. US-guided labeling techniques in human cadavers are a widespread tool to examine new nerve block techniques through staining targeted nerves by dye and investigating staining quality and quantity by dissecting. These results suggest that PENG block should be further investigated on cadavers to determine the MEV90 for the targeted nerves of the PENG block and to test possible novel injection pathways of these nerves.

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A comparative study of 0.2% ropivacaine with dexamethasone versus fentanyl in PENG block

Apte,

Mehta,

Adate

et al. 2024

IJCA

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The PENG block is recognized for its motor-sparing effect, setting it apart from the femoral nerve block. This interfascial plane block provides good analgesia for proximal femur fracture surgeries. The primary objective of the research was to analyze the efficacy of Dexamethasone and Fentanyl with Ropivacaine in PENG block for proximal femur surgeries, while the secondary objective was to evaluate the comfort of patients while positioning for spinal anesthesia and any potential side effects. The study involved 60 patients, classified as ASA grade I/II, split into two groups of 30. Group PD was given 0.2%Ropivacaine (15ml), with Dexamethasone 4mg, and Group PF was given 0.2% Ropivacaine (15ml), with Fentanyl 50mcg in USG guided PENG block. The study documented VAS score before and 10 minutes after the PENG block, patient satisfaction score, postoperative duration of analgesia, hemodynamic effects and adverse effects. In both the groups, VAS score before (6.567±1.223 vs6.5±1.252, p=0.408) and 10 minutes after PENG block (2.167±0.791vs2.234±0.728, p=0.365) and patient satisfaction score (2.1±0.759vs2±0.743, p=0.328) were comparable i.e. statistically insignificant. The postoperative duration of analgesia (655.334±35.457 mins in group PD vs 458.334±27.518 mins in group PF, p- value=0.004), was statistically significant. No significant hemodynamic effects or side effects were observed.PENG block has the potential to be beneficial for both preoperative positioning and postoperative pain management. We conclude that Dexamethasone (4mg) and Fentanyl (50 mcg) provide comparable analgesic efficacy as an adjuvant to 0.2% Ropivacaine in the early postoperative period, but Dexamethasone provides a prolonged duration of analgesia.

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Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Cited by 3 publications

References 34 publications

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Pericapsular Nerve Group (PENG) Block on Cadavers: A Scoping Review

A comparative study of 0.2% ropivacaine with dexamethasone versus fentanyl in PENG block

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