Pericapsular nervegroup (PENG) block—a scoping review

Abstract

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.

Novel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report

“…Nevertheless, there are no high-quality data available to determine the optimum volume of local anesthetic agent to be used for this block 8 11. The most common range reported within the literature is between 10 and 20 mL11 and cases of unwanted motor block, in the form of quadricep weakness may be witnessed with the use of higher volumes 8 12. Our patient did not report any quadricep weakness during the 7 days when the nerve catheter was in place.…”

“…Its indications and applications are still expanding and are limited to retrospective case series, case reports, and commentary reports. To date, the PENG block has been used as an analgesic or anesthetic technique in open and arthroscopic hip surgery, acetabular fracture, assist positioning patients with hip fractures for spinal anesthesia, surgery of medial thigh including vein ligation, in the prevention of adductor muscle spasm during transurethral resection of bladder tumor, and opioid-resistant hip vaso-occlusive crisis 8. Furthermore, majority of the reported clinical use of the PENG block is with a single injection of local anesthetic agent(s).…”

“…In response, we increased the PIB volume to 15 mL every 2 hours and subsequently observed a further clinical improvement in our patient’s condition. Nevertheless, there are no high-quality data available to determine the optimum volume of local anesthetic agent to be used for this block 8 11. The most common range reported within the literature is between 10 and 20 mL11 and cases of unwanted motor block, in the form of quadricep weakness may be witnessed with the use of higher volumes 8 12.…”

Comparison of the pericapsular nerve group block with the intra-articular and quadratus lumborum blocks in primary total hip arthroplasty: a randomized controlled trial

“…The primary outcome measure was defined as the maximum severity of pain perceived at all postoperative time points (3,6,8,12,24, and 48 h), using a 0-10 NRS.…”

“…In hip fracture surgery and elective arthroplasty, preoperative and postoperative analgesic blockade is applied to the obturator nerve (ON), femoral nerve (FN) and accessory obturator nerves (AON), which provide innervation to the anterior side of the hip joint [5]. With this block, only the sensory branches of the FN that go to the hip joint are blocked, so there is no motor blockage [6]. Consequently, excellent analgesia can be provided without affecting muscle strength which facilitates postoperative functional recovery.…”