Reduced Opioid Consumption with Pericapsular Nerve Group Block for Hip Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

The pericapsular nerve group (PENG) block targets the nerves innervating the anterior hip surface; however, few studies on this technique are currently available. We investigated the effects of the PENG block on postoperative opioid consumption after a hip surgery. This was a randomized, double-blind, placebo-controlled study conducted at a single institution. Fifty patients undergoing hip surgery were randomly allocated, 25 in each group, to receive a PENG block either using 25 mL of 0.5% ropivacaine (PENG group) or 25 mL of saline (control group). The primary outcome was the total opioid consumption 24 h postoperatively. The secondary outcomes were postoperative pain scores, time to first opioid demand, sensory block efficiency, quadriceps muscle strength, complications, and patient satisfaction. Compared with those in the control group, patients in the PENG group had a significantly lower total opioid consumption 24 h postoperatively (440.72 ± 242.20 μg vs. 611.07 ± 313.89 μg, P = 0.037) and significantly lower pain scores at 30 min postblock and 6 postoperatively ( P < 0.001 and P < 0.001 , respectively). The time to first opioid demand was significantly shorter in the control group than in the PENG group P < 0.001 . Sensory block effectiveness was better in the PENG group 30 min postblock and 6 and 12 h postoperatively than in the control group. Patient satisfaction was also better in the PENG group than in the control group. There were no differences in the other outcomes. The PENG block reduced the total opioid consumption in the first 24 h after hip surgery with no significant effects on quadriceps muscle strength and complication rate. This study was registered at the Korea Clinical Research Information Service (cris.nih.go.kr; Reg. No. KCT0006348) on July 16, 2021.

Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study

“…Patient satisfaction was observed by their willingness to accept the block in the future, which was better in the PENG group (94%) than in the FNB group (77%). This was similar to other studies that have observed good patient satisfaction scores [ 20 , 25 , 26 ]. There were no significant hemodynamic changes or block-related adverse effects in both groups.…”

“…In yet another cohort study performed by Sahoo et al, USG-guided PENG block was administered to 20 consecutive patients posted for hip fracture surgeries and inferred significant drop of six to seven points in VAS scores at rest (baseline: 7.45 ± 1.53; 30 minutes after block: 1.1 ± 1.07) and with movement (baseline: 9.45 ± 0.75; 30 minutes after block: 2.35 ± 1.34) during positioning the patients for SA [ 25 ]. There are many other case series, placebo-controlled trials with PENG block, and trials comparing PENG with other established blocks like fascia iliaca block demonstrating similar results [ 14 , 18 , 26 - 30 ].…”

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

“…It has shown decreased opioid consumption in the first 24 h postoperatively and decreased pain scores in the short-term postoperative period and post-anesthesia care unit after open hip surgeries compared to sham block and compared to conventional postoperative analgesia. 21 , 25 , 26 …”

Comparison of the Effect of Pericapsular Nerve Group Block Combined with Lateral Femoral Cutaneous Nerve Block and Fascia Iliaca Compartment Block in Patients Undergoing Hip Arthroscopy Under General Anesthesia: A Randomized, Double-Blind Trial

“…More importantly, the PENG block blocks only the joint branches of the nerves, causing no motor impairment, and promotes early postoperative ambulation, lowering the likelihood of serious problems such as thrombosis of the deep veins and enhancing postoperative recovery quality. 11 Incisional pain is also a significant source of postoperative pain in patients with AHS. The lateral femoral cutaneous nerve block (LFCN) provides most of the cutaneous innervation to the surgical site.…”