Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial

Kukreja, Promil; Uppal, Vishal; Kofskey, Alexander M; Feinstein, Joel; Northern, Theresa; Davis, Camille; Morgan, Charity; Kalagara, Hari

doi:10.1016/j.bja.2023.02.017

Cited by 30 publications

(24 citation statements)

References 21 publications

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“…The characteristics and outcomes of the included studies are shown in Table 1. The 12 RCTs involved 705 patients 23,31–41 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 .…”

Section: Resultsmentioning

confidence: 99%

“…The 12 RCTs involved 705 patients 23,31–41 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 34…”

Section: Resultsmentioning

confidence: 99%

“…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 23,32–35,37,40,41 . 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: Resultsmentioning

confidence: 99%

“…Only 1 study used the same concentration and volume of local anesthetic for the active comparator and the PENG group 38 . Eleven out of 12 studies 23,31–37,39–41 used ultrasound to perform these blocks and one did not specify 38 . Nerve block adjuvants such as dexamethasone, dexmedetomidine, or long-acting local anesthetic such as liposomal bupivacaine were not used in any included study; however, 1 study used clonidine as an adjuvant 38 and 5 studies used epinephrine in the block 32,36,37,39,40 .…”

Section: Resultsmentioning

confidence: 99%

“…One study 38 did not provide enough detail regarding differential rates of dropout (bias due to missing outcome data). Nine studies 23,31–33,36,37,39–41 provided details to assess the blinding of outcome assessors (bias in the measurement of outcomes). One study 38 did not provide enough details to detect the risk of bias in the selection of the reported result.…”

Section: Resultsmentioning

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

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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Use of Peripheral Nerve Blocks for Total hip Arthroplasty

Grinman,

Elmore,

Ardon

et al. 2024

Curr Pain Headache Rep

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Purpose of Review The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations. Recent Findings Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. Summary New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by provider comfort, surgical approach, patient anatomy, and postoperative goals. Head-to-head studies of particular nerve blocks are warranted.

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Hip fracture analgesia: how far ahead are we?

Ramlogan,

Uppal

2023

Can J Anesth/J Can Anesth

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Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial

Cited by 30 publications

References 21 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

Use of Peripheral Nerve Blocks for Total hip Arthroplasty

Hip fracture analgesia: how far ahead are we?

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