The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis

Abstract

Introduction Patients with hip surgery often experience moderate to severe postoperative pain, and need large doses of opioids to relieve it, which is not conducive to patient rehabilitation. Pericapsular nerve group (PENG) block is a new regional block technique that is considered to reduce postoperative pain and the use of opioids. The purpose of this study was to evaluate the efficacy and safety of PENG block for postoperative analgesia after hip surgery. Methods We searched multiple databases for randomized controlled trials (RCTs) published in English, which compared PENG block with fascia iliaca compartment block (FICB). The primary outcome was 24 h postsurgical opioid consumption (OC). The secondary outcomes were pain scores (PSs) at different timepoints after surgery and the incidence of postoperative nausea and vomiting (PONV). Results Five RCTs involving 234 patients were selected for our analysis. Our results show that the 24 h OC was drastically lower in PENG block versus FICB patients (SMD −0.60, 95% CI −1.08 to −0.11); P < 0.05, I 2 = 69%). At the same time, there were no significant difference in postsurgical PSs between the two cohorts (6 h: MD −0.07, 95% CI −0.67 to 0.53; P = 0.82, I 2 = 43%; 12 h: MD −0.60, 95% CI −1.40 to 0.19; P = 0.14, I 2 = 31%; 24 h: MD 0.17, 95% CI −0.87 to 1.21; P = 0.75, I 2 = 76%; 36 h: MD 0.80, 95% CI −0.92 to 2.51; P = 0.36, I 2 = 73%; 48 h: MD −0.06, 95% CI −0.75 to 0.63; P = 0.86, I 2 = 0%) and the incidence of PONV (RR 1.00, 95% CI 0.40–2.50, P = 1.00, I 2 = 35%). Conclusions Our research shows that PENG block can reduce the use of opioids after hip surgery and is effective in postoperative analgesia. Future research should explore the injection method, concentration, and dosage.

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

“…Based on the meta-analysis of Gao et al and Cai et al [ 21 , 22 ]. On the analgesic effect of FICB after total hip replacement, there was a significant difference between placebo and FICB regarding the pain score at 12 h. According to the results of previous meta-analyses about PENG, PENG and FICB were similar in postoperative pain control [ 3 , 12 ]. On the basis of the above two conclusions, we may conclude that there was a significant difference between placebo and PENG regarding the pain score at 12 h. However, our meta-analysis didn’t make definitive conclusions due to the included RCT studies lacking data on 12-h pain scores.…”

“…However, it is usually accompanied by moderate to severe pain after surgery [ 2 ]. Severe postoperative pain can affect patients' normal functional rehabilitation training, prolong the time to hospital discharge, and increase the risk of postoperative complications such as lower limb thrombosis and pneumonia [ 3 , 4 ]. 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 ].…”

“…PENG relieves pain by blocking the obturator nerve (ON), accessory obturator nerve (AON), and femoral nerve of the anterior capsule of the hip, which is theoretically less likely to cause quadriceps block than some peripheral nerve blocks such as the femoral nerve block (FNB) and fascia iliaca compartment block (FICB) [ 9 – 11 ]. By comparing pericapsular nerve block anesthesia with other different regional nerve block anesthesia in hip fractures, Liang Yu and Wang Yi's meta-analysis reported that PENG block provides effective analgesia, similar to FICB and other regional nerve blocks in hip surgery [ 3 , 12 ]. However, these meta-analyses, like most of the published literature about pericapsular nerve group block, included different types of hip surgery and different treatment of controls, so the results should be viewed with caution.…”

Effects of Different Volumes of Ropivacaine for Pericapsular Nerve Group Block on Incidence of Quadriceps Weakness and Analgesic Efficacy Following Hip Arthroplasty: A Randomized Controlled Trial

“…The utilization of ultrasound-guided PENG block as an approach to providing perioperative analgesia to patients undergoing hip surgery is becoming increasingly common [ 9 , 10 ]. While PENG block can yield satisfactory analgesic efficacy, it also has the potential to block the function of the femoral nerve [ 11 ].…”

Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial

“…It targets periarticular sensory branches derived from the femoral, obturator and accessory obturator nerves innervating the anterior hip capsule [2]. Since 2021, many trials have been published demonstrating its efficacy in managing perioperative pain after hip arthroplasty without affecting functional recovery [3]. However, PENG block does not involve other anatomical structures affected by postsurgical stress, such as skin, periarticular fascias, muscles and posterior capsula.…”