Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty

Abstract

BackgroundThis randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%).MethodsSixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay.ResultsThere were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours).ConclusionFor primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration.Trial registration numberNCT05087862.

Motor-sparing peripheral nerve blocks for hip and knee surgery

“…Regarding quadriceps muscle strength, no significant difference was found between groups [9 ▪ ]. In a 60-patient RCT of PENG block versus PAI, there was no difference in quadriceps motor strength after 3, 6, and 24 h [10 ▪ ].…”

Use and Clinical Relevancy of Pericapsular Nerve Block (PENG) in Total Hip Arthroplasty - A Systematic Review and Meta-analysis

“…The characteristics and outcomes of the included studies are shown in Table 1. The 12 RCTs involved 705 patients 23,[31][32][33][34][35][36][37][38][39][40][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.…”

“…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 Two studies administered periarticular infiltration in both groups, in which 64 of them were in the PENG block group.…”

“…23,31 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][33][34][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.…”

Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty

“…This randomized trial1 compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%).…”