The Use of Pericapsular Nerve Group (PENG) Block in Hip Surgeries Is Associated With a Reduction in Opioid Consumption, Less Motor Block, and Better Patient Satisfaction: A Meta-Analysis

Huda, Anwar Ul; Ghafoor, Hashsaam

doi:10.7759/cureus.28872

Cited by 14 publications

(18 citation statements)

References 37 publications

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“…Statistically, PENG block seemed to be as effective as other types of nerve blocks for alleviating pain after hip surgery. We note that the pooled result of postoperative 24-h morphine consumption in published relevant meta-analysis is inconsistent with ours (27). Due to different perspectives and inclusion criteria, the included studies are not quite the same.…”

Section: Discussioncontrasting

confidence: 71%

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Shen²,

Li³

2023

Front. Med.

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BackgroundAs an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery.MethodsA total of 497 academic articles were identified after a systematic search in the databases of PubMed, Embase, Web of Science, and Cochrane Library up to 25 August 2022. The primary outcome was postoperative 24-h morphine consumption. Secondary outcomes included the time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and incidence of postoperative nausea and vomiting (PONV). We calculated mean differences (MDs) with 95% confidence intervals (CIs) for postoperative 24-h morphine consumption, time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and odds ratios (ORs) with 95% CIs for incidence of PONV. The chi-square test was used for heterogeneity analysis, and heterogeneity was assessed by I2. Statistical analysis was performed using Review Manager 5.4.ResultsNumerous electronic databases were searched, and finally, nine studies were identified. There was no significant difference in morphine consumption during the postoperative 24 h [MD: −2.57, 95% CI: (−5.42, 0.27), P = 0.08] and the time of the first request for rescue analgesia [MD: 1.79, 95% CI: (−1.06, 4.64), P = 0.22] between the PENG block and control groups. PENG block did not reveal a significant difference in 6 h [MD: −0.17, 95% CI: (−0.92, 0.57), P = 0.65] [MD: −0.69, 95% CI: (−1.58, 0.21), P = 0.13] and 24 h [MD: −0.25, 95% CI: (−1.54, 1.05), P = 0.71], [MD: 0.05, 95% CI: (−0.84, 0.93), P = 0.91] static and dynamic pain scores compared with other nerve block methods. Moreover, the two groups have a similar risk of PONV (OR: 1.29, 95% CI = 0.53–3.10, P = 0.57).ConclusionThis review shows that PENG block can act as an alternative multimodal analgesia for hip surgery, and compared with the other kinds of nerve block, there was no significant difference in the postoperative analgesic effect of PENG block.Systematic review registrationSupplementary Datasheet 1, identifier: CRD 42022356496.

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Section: Discussioncontrasting

confidence: 71%

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Shen²,

Li³

2023

Front. Med.

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“…The articular branches of the FN, ON and AON are consistently found here. A pooled meta-analysis done by Huda et al demonstrated complete analgesia with less incidence of motor blockade and better range of motion leading to a shorter time to first walk postoperatively with PENG block in patients with hip arthroplasty [ 14 ]. The encouraging results were found with PENG block over other regional blocks as well such as femoral nerve block or fascia iliaca compartment block with no differences in static and dynamic pain scores as well as cumulative opioid consumption during 48 hours with preservation of quadriceps muscle strength after total hip arthroplasty [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…This will help to enhance the quality and duration of analgesia as observed by Jadon et al and Roy et al [ 16 , 17 ]. Many authors have used PENG block with different volumes of local anesthetics from 10 ml to 30 ml to provide analgesia after hip surgery, which could obscure the discrepancy of their results [ 14 - 20 ]. Reviewing the fluoroscopic and cadaveric study, the spread of 5, 10, 15 and 20 ml dye when injected below the psoas tendon and over the superior pubic ramus, adequate diffusion was found with 10 ml volume as well.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, finding the balance in the modality of analgesia plays a key role in the “goldilocks condition” [ 2 ]. Huda et al demonstrated significantly reduced opioid consumption in the first 24 hours after surgery and highly extended duration to the first demand of rescue analgesia with the PENG block usage for patients undergoing hip surgery [ 14 ]. Authors have reported reduced requirement of morphine in patients with fractured neck femur 24 hours postoperatively [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series

Desai¹,

Shah²,

Bumiya³

2023

Cureus

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Background: The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery.Method: We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively.Result: The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. Conclusion:Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.

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“…Huda AU et al showed similar results regarding opioid consumption within the first 24 hours and duration of analgesia. They concluded that PENG block for hip surgery patients is associated with a substantial decrease in opioid intake (0.54 mg) in the first 24 hours following surgery (p=0.05) and increased duration of analgesia in the postoperative period [ 10 ]. Based on our study, the time for the first rescue analgesic requirement was substantially more in group B (445.0 minutes) than in group A (388.9 minutes) (p<0.05).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Study Comparing Ropivacaine and Ropivacaine With Dexamethasone

Balasubramaniam¹,

Naggaih²,

Tarigonda³

et al. 2023

Cureus

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Background: Patients with hip fractures will be experiencing excruciating pain, which would prevent the ideal positioning of the patient for the neuraxial blockade. There is growing interest in using regional nerve blocks for pain in the elderly associated with a fractured hip. Pericapsular Nerve Group (PENG) block is gaining popularity as a provider of adequate analgesia in patients suffering from a hip fracture. The present study aimed to assess the effectiveness of PENG block using ropivacaine alone or ropivacaine with dexamethasone in reducing pain scores during patient positioning for the central neuraxial blockade and to compare the duration of postoperative analgesia.Materials and methods: This randomized double-blinded study was conducted on patients posted for hip surgery under spinal anesthesia at a tertiary care referral hospital between January 2021 and May 2022. Twenty-eight patients (14 in each group) were randomly allocated to receive either group A (20 ml of 0.5% ropivacaine for PENG block) or Group B (20ml of 0.5% ropivacaine with 8mg Dexamethasone for PENG block) before patient positioning for subarachnoid block. Intra-operative hemodynamic variables, pain scores on a visual analog scale (VAS), at rest and with movement, before block, at the time of positioning for spinal anesthesia, time for first rescue analgesic request, and the total dosage of rescue analgesia in the first 24 hours after PENG block were measured.Results: Pain scores at rest and with movement at baseline and at the time of positioning for spinal anesthesia were significant within the groups (p< 0.01). The time for the first rescue analgesic requirement was significantly longer in group B (445.0 ±17.4 minutes) than in group A (388.9±19.0 minutes) (p<0.05). The mean average number of doses of rescue analgesia (Tramadol in milligrams) was significantly lower in group B (190 ± 60) than in group A patients (250 ± 70) (p<0.05). Conclusion:The present study documented the effectiveness of PENG for patient positioning during the neuraxial blockade. Further, the addition of dexamethasone as an adjunct to ropivacaine yields a significantly longer duration of postoperative analgesia with a lower postoperative analgesic requirement.

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The Use of Pericapsular Nerve Group (PENG) Block in Hip Surgeries Is Associated With a Reduction in Opioid Consumption, Less Motor Block, and Better Patient Satisfaction: A Meta-Analysis

Cited by 14 publications

References 37 publications

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series

Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Study Comparing Ropivacaine and Ropivacaine With Dexamethasone

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