Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Abstract

This study compared the effects of the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on postoperative analgesia and quadriceps strength following total hip arthroplasty under general anesthesia. A total of 58 patients were randomized to receive either PENG block (PENG group) or supra-inguinal FICB (FICB group) following anesthetic induction. The primary outcomes were the postoperative pain scores. Patients were randomized to receive either PENG block or supra-inguinal FICB following anesthetic induction. Pain scores at rest and with movement were assessed preoperatively, at the postanesthesia care unit (only at rest), and at 6, 24, 36, and 48 h postoperatively. Opioid consumption was also assessed for 48 h postoperatively. Quadriceps strength measurements were performed preoperatively, at 6, 24, and 36 h postoperatively. In total, 54 patients completed the study: 27 in the PENG group and 27 in the FICB group. Despite lower pain scores at rest in the PENG group at postoperative 6 and 24 h, there were no significant differences in the pain scores at rest and during movement between the two groups during postoperative 48 h in the linear mixed model analysis (p = 0.079 and p = 0.323, respectively). Cumulative opioid consumption up to postoperative 48 h was also similar in the two groups (p = 0.265). The changes in quadriceps strength measurements in the operative leg and the nonoperative leg were not significantly different between the groups (p = 0.513 and p = 0.523, respectively). The PENG block may have similar analgesic efficacy to the supra-inguinal FICB. No difference was detected in the quadriceps strength between the patients receiving these two blocks.

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

“…Based on the Cochrane risk of the bias assessment tool, the quality of the included studies ranged from low to high quality with seven studies of low quality [15][16][17][18][19][20][21]; two of moderate quality [22,23]; and six high-quality studies [24][25][26][27][28][29]. Risk of bias graph and summary of quality assessment domains of included studies are shown in Figs.…”

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

“…Among clinical studies utilizing PENG block ( n = 29), most are low-quality case reports/series [ 1 , 2 , 3 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], but one cohort study [ 59 ] and eight randomized controlled trials [ 4 , 5 , 60 , 61 , 62 , 63 , 64 , 65 ] appeared in the literature after late 2020. Definite post-procedural quadriceps weakness after PENG block was reported in two case reports [ 2 , 3 ] and two RCTs [ 4 , 5 ] (group A).…”

“…Definite post-procedural quadriceps weakness after PENG block was reported in two case reports [ 2 , 3 ] and two RCTs [ 4 , 5 ] (group A). Among PENG block studies that reported no post-procedural quadriceps weakness or made no mention of motor function at all, clinical manifestations of extra-IP spread of local anesthetics either as observed injectate spread to the FIC in ultrasound images [ 42 ], sensory loss of dermatomes corresponding to the femoral nerve [ 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ], or an absence of statistically significant difference in quadriceps strength in patients receiving a supra-inguinal fascia iliaca compartment block (SI-FICB) [ 60 , 61 ] were found in nine case reports/series [ 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ] and two RCTs [ 60 , 61 ] (group B). Nine case reports/series [ 1 , 48 , 52 , 54 , 55 , 56 , 57 , 64 , 66 ], one cohort study [ 60 ], and four RCTs [ 62 , 63 , 64 , 65 ] using PENG block specifically reported no motor block at all (group C).…”

“…While most of these studies are low-quality case reports, two recent RCTs also showed hints of a potential post-operative motor block. Choi et al [ 60 ] and Senthil et al [ 61 ] both compared the post-operative quadriceps muscle strength after PENG block and SI-FICB and found no statistically significant difference between these two groups. Since a successful SI-FICB necessitates blocking the femoral nerve proper, their results implied that femoral nerve proper involvement after PENG block might be more frequent than previously expected.…”

“…Based on the injectate spread behavior observed in IPB ( Figure 4 ), we then produced a model of injectate spread behavior after PENG block ( Figure 7 ) according to the deduced routes of spread from the currently available PENG block clinical studies ( Table 1 ). After PENG block, the most frequently observed route of spread was medial fascial plane (bursal) spread [ 1 , 2 , 5 , 42 , 48 , 52 , 57 , 58 , 60 , 62 , 64 , 65 ], followed by lateral fascial plane spread [ 42 , 52 , 55 , 57 ] and superficial intramuscular spread of the iliopsoas complex [ 2 ] ( Table 1 ). Note that the frequency of superficial intramuscular spread is very likely to be underestimated since its occurrence could not be readily distinguished from the static images provided by these studies.…”