The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty: Systematic Review and Direct Meta-Analysis

Fillingham, Yale A.; Hannon, Charles P.; Kopp, Sandra L.; Sershon, Robert A.; Stronach, Benjamin M.; Meneghini, R. Michael; Abdel, Matthew P.; Griesemer, Margaret E.; Austin, Matthew S.; Casambre, Francisco; Woznica, Anne; Nelson, Nicole; Hamilton, William G.; Valle, Craig J. Della

doi:10.1016/j.arth.2022.04.035

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…However, there has yet to be a quality RCT directly comparing IPB to PENG block in THA, hip arthroscopy, or following hip fracture. Finally, a multisociety meta-analysis of 11 studies by Fillingham et al showed reduced postoperative pain scores and opioid consumption when peripheral nerve blocks (single injection quadratus lumborum, FICB, and lumbar plexus block), PAI, or combinations of methods were compared with placebo for primary THA [29 ▪▪ ]. However, when compared with one another, there were no differences between the different techniques.…”

Section: Comparative-effectiveness Studies On Blocks For Hip Surgerymentioning

confidence: 99%

Motor-sparing peripheral nerve blocks for hip and knee surgery

Restrepo-Holguin,

Kopp,

Johnson

2023

Current Opinion in Anaesthesiology

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Purpose of review To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. Recent findings Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation. Summary The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.

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Section: Comparative-effectiveness Studies On Blocks For Hip Surgerymentioning

confidence: 99%

Motor-sparing peripheral nerve blocks for hip and knee surgery

Restrepo-Holguin,

Kopp,

Johnson

2023

Current Opinion in Anaesthesiology

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“…Concluding that “QLB [quadratus lumborum blocks] as part of multimodal analgesia did not result in any significant analgesic benefits,” the authors recommended further trials to verify these results. In a systematic review and direct meta-analysis, Fillingham et al reported that the role for any peripheral nerve block in the management of patients undergoing THA may be in question 13 . After reviewing 3,382 publications and selecting the 11 representing the best available evidence, the authors examined the fascia iliaca, lumbar plexus, and quadratus lumborum blocks and periarticular anesthetic infiltration.…”

Section: Perioperative Managementmentioning

confidence: 99%

What’s New in Hip Surgery

Morgan

Gannon

2023

Journal of Bone and Joint Surgery

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“…At present, a variety of analgesic methods can be used as postoperative analgesia methods in THA, including patient-controlled opioid analgesia, local infiltration analgesia around the joint, epidural analgesia, and peripheral nerve block [ 5 ]. Regional nerve blocks may also be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty [ 6 ]. Pericapsular nerve group block (PENG) is a new regional block proposed by Giron-Arango et al [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of pericapsular nerve group block for reducing pain and opioid consumption after total hip arthroplasty: a systematic review and meta-analysis

She,

Liu

2024

J Orthop Surg Res

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Background Pericapsular nerve group block (PENG) is an emerging regional anesthesia technique for hip surgery. However, its efficacy in total hip arthroplasty (THA) isn’t well defined. We perform this meta-analysis aiming to assess the effect of Pericapsular nerve group block on pain control and morphine consumption in patients with total hip arthroplasty. Methods We searched four electronic databases (Pubmed, Embase, Cochrane Library, and Web of Science dated from 2018 to October 2023) for published eligible randomized controlled trials (RCTs) comparing PENG with placebo (no block/sham block) after THA. The outcome measurements consisted of pain score, opioid consumption, Time to first opioid, and postoperative complications. All data analyses were performed using STATA 12.0. Results Five RCTs comprising 808 participants were included. Our meta-analysis showed that there were significant differences between two groups in terms of pain score in PACU (WMD = − 0.598, 95% CI [− 0.886, − 0.310], P < 0.001), pain score at 6 h (WMD = − 0.614, 95% CI [− 0.835, − 0.392], P < 0.001) and time to first opioid (WMD = 5.214, 95% CI [4.545, 5.883], P < 0.001). However, no significant differences were revealed from the pain score at 24 h after THA (WMD = − 0.924, 95% CI [− 1.929, 0.081], P = 0.072). Meanwhile, the meta-analysis indicated that PENG significantly reduced 24-h opioid consumption (WMD = − 6.168, 95% CI [− 6.667, − 5.668], P < 0.001) and 48-h opioid consumption (WMD = − 7.171, 95% CI [− 8.994, − 5.348], P < 0.001). Conclusion Pericapsular nerve group block was effective for pain control up to postoperative 6 h and extending the time to the first opioid after THA. Moreover, it reduced postoperative opioid consumption when compared with a placebo group. Due to the high heterogeneity of the pain score after 24 h and the low-quality evidence, more high-quality RCTs are required to draw a definitive conclusion about pain control.

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The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty: Systematic Review and Direct Meta-Analysis

Cited by 11 publications

References 17 publications

Motor-sparing peripheral nerve blocks for hip and knee surgery

Motor-sparing peripheral nerve blocks for hip and knee surgery

What’s New in Hip Surgery

The efficacy of pericapsular nerve group block for reducing pain and opioid consumption after total hip arthroplasty: a systematic review and meta-analysis

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