The pericapsular nerve group (PENG) block for hip surgery. A narrative review

• Authors: Tomasz Reysner , Grzegorz Kowalski , Monika Grochowicka , Danuta Domagalska

Title variants

PL

Blokada okołopanewkowej grupy nerwów (PENG) w zabiegach w obrębie stawu biodrowego. Przegląd narracyjny

Abstracts

PL

Wstęp. Leczenie bólu okołooperacyjnego związanego z operacją stawu biodrowego jest bardzo wymagające. Blokada grupy nerwów okołopanewkowych (PENG) to nowa technika anestezji regionalnej, która zapewnia lepszą analgezję pooperacyjną, nie upośledzając funkcji motorycznych.
Cel. Celem tego przeglądu jest ocena bezpieczeństwa i skuteczności blokady PENG w leczeniu bólu pooperacyjnego u pacjentów poddawanych operacjom stawu biodrowego.
Metody. Literatura została przejrzana za pośrednictwem czterech elektronicznych baz danych: PubMed, Cochrane Library, Google Scholar i Embase.
Wyniki. Wstępne wyszukiwanie przyniosło 416 artykułów. Wybrano dwadzieścia siedem odpowiednich artykułów na podstawie trafności, aktualności, jakości wyszukiwania i cytowań. Dwanaście badań dotyczyło pacjentów poddawanych całkowitej alloplastyce stawu biodrowego z powodu zaawansowanej
choroby zwyrodnieniowej. Dwanaście badań dotyczyło pacjentów poddawanych całkowitej operacji stawu biodrowego z powodu złamania szyjki kości udowej. Wreszcie trzy badania dotyczyły pacjentów poddawanych artroskopii stawu biodrowego.
Wnioski. Blokada PENG zapewnia lepszą analgezję i niskie zużycie opioidów w bezpośrednim okresie pooperacyjnym. Jednak obecne dowody są niewystarczające i istnieje potrzeba przeprowadzenia wysokiej jakości randomizowanych badań kontrolowanych z większymi próbami.

EN

Introduction. Perioperative pain management associated with hip surgery is challenging. The pericapsular nerve group (PENG) block is a new technique thought to provide better postoperative analgesia in addition to its motor-sparing effects.
Aim. This review aims to evaluate the safety and efficacy of the PENG blockade in managing postoperative pain in patients undergoing hip surgery.
Methods. The literature was reviewed through four electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase.
Results. The initial search yielded 416 articles. Twenty-seven relevant articles were selected based on relevance, recentness, search quality, and citations. Twelve of the studies were related to patients undergoing total hip arthroplasty. Twelve studies were related to patients undergoing total hip surgery due to hip fracture. Finally, three studies were related to patients undergoing hip arthroscopy.
Conclusions. The PENG block provides superior analgesia and low opioid consumption in the first postoperative period. However, current evidence is insufficient, and there is a need for high-quality randomized, controlled trials with larger sample sizes.

Keywords

EN

coxarthrosis; pain management; opioids; peripheral nerve block; hip arthroscopy; hip alloplasty; hip replacement

PL

choroba zwyrodnieniowa stawów; leczenie bólu; opioidy; blokada nerwów obwodowych; artroskopia stawu biodrowego; alloplastyka stawu biodrowego; endoprotezoplastyka stawu biodrowego

• Publisher: Wydawnictwo Exemplum
• Journal: Chirurgia Narządów Ruchu i Ortopedia Polska
• Year: 2023
• Volume: 88
• Issue: 1
• Pages: 17-24

Dates

published

2023

Contributors

author

Tomasz Reysner

• Department of Anesthesiology and Intensive Care, W.Dega Orthopedic and Rehabilitation Clinical Hospital, University of Medical Sciences, Poznań, Poland

author

Grzegorz Kowalski

• Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland

• https://orcid.org/0000000232064426

author

Monika Grochowicka

• Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland

• https://orcid.org/0000000215110750

author

Danuta Domagalska

• Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland

• https://orcid.org/0000000290670969

References

• Bünemann PC, Luck S, Ohlmeier M, Gehrke T, Ballhause TM: Dislocation of a McMinn-like prosthesis with distinctive metallosis and fracture of the Os Ilium. Case Rep Orthop. 2021;2021.
• Guerra ML, Singh PJ, Taylor NF: Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil. 2015;29(9):844–54.
• Chen YR, Chen YL, Chen WY, Lin YC, Jane SW: Evidence-based nursing care of older adult patient with postoperative delirium and hip fracture. Hu Li Za Zhi. 2021;68(1):90–6.
• Harper CM, Lyles YM: Physiology and complications of bed rest. J Am Geriatr Soc. 1988;36(11):1047–54.
• Jabłoński M, Turzańska K, Gorzelak M, Posturzyńska A, Wójcik B, Pluta R: Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important? Chir Narzadow Ruchu Ortop Pol. 2008;73(6):381–5.
• Pu X, Sun J.: General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: a meta-analysis. Medicine (Baltimore). 2019;98(16).
• Opperer M, Danninger T, Stundner O, Memtsoudis SG: Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence-based review. World J Orthop. 2014;5(3):336.
• Juszkiewicz S: The application of local infiltration analgesia as multimodal analgesia in postoperative pain managment after total knee arthroplasty – review of the literature. Chir Nsrzodow Ruchu Ortop Pol. 2019;84(1):33–6.
• Guay J, Parker MJ, Griffiths R, Kopp SL: Peripheral nerve blocks for hip fractures: a Cochrane review. Anesth Analg. 2018;126(5):1695– 704.
• Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, et al.: Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025–35.
• Morrison C, Brown B, Lin DY, Jaarsma R, Kroon H: Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review. Reg Anesth Pain Med. 2021;46(2):169–75.
• Girón-Arango L, Peng PW, Chin KJ, Brull R, Perlas A: Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43(8):859–63.
• Kolomachenko V: Efficiency of pericapsular nerve group block after hip arthroplasty. Georgian Med News. 2021;(320):18–22.
• Mistry T, Sonawane KB, Kuppusamy E: PENG block: points to ponder. Reg Anesth Pain Med. 2019;44(3):423–4.
• Çiftçi B, Ahıskalıoğlu A, Altıntaş HM, Tekin B, Şakul BU, Alıcı HA: A possible mechanism of motor blockade of high-volume pericapsular nerve group (PENG) block: A cadaveric study. J Clin Anesth. 2021.
• Pascarella G, Costa F, Del Buono R, Pulitanò R, Strumia A, Piliego C, et al.: Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial. Anaesthesia. 2021;76(11):1492–8.
• Zheng J, Pan D, Zheng B, Ruan X: Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebocontrolled trial. Reg Anesth Pain Med. 2022;47(3):155–60.
• Patel V, Patel V, Abdallah F, Whelan D, Bansal S, Gabra M, et al.: The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. Reg Anesth Pain Med. 2022;47(12):733–7.
• Amato PE, Coleman JR, Dobrzanski TP, Elmer DA, Gwathmey FW, Slee AE, et al.: Pericapsular nerve group (PENG) block for hip arthroscopy: a randomized, double-blinded, placebo-controlled trial. Reg Anesth Pain Med. 2022;47(12):728–32.
• Chung CJ, Eom DW, Lee TY, Park SY: Reduced Opioid Consumption with Pericapsular Nerve Group Block for Hip Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. Pain Res Manag. 2022;2022.
• Martín AM, Herrero MP, Quirós BS, Herrero RL, Bueno PR, Crespo SC: [Translated article] Benefits of analgesic blocks, PENG block (PEricapsular Nerve Group), in fast recovery after hip surgery. Rev Espanola Cirugia Ortop Traumatol. 2023;67(1):T27–34.
• Remily EA, Hochstein SR, Wilkie WA, Mohamed NS, Thompson JV, Kluk MW, et al.: The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? HIP Int. 2022;32(3):318–25.
• Gupta N, Das S, Chatterjee N, Munjal M: A Retrospective Study of Ultrasound-Guided Pericapsular Nerve Group Block With Dexamethasone: An Excellent Option for Early Mobility Following Total Hip Replacement Surgery. Cureus. 2022;14(12).
• Güllüpınar B, Sağlam C, Ünlüer EE, Ayvat P, Öztürk K, Gül M, et al.: Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department. Ulus Travma Acil Cerrahi Derg. 2022;28(6):832–8.
• Tavares BS, Machado RDA, Arruda UTD, Oliveira LAD: Does pericapsular anesthetic block improve the postoperative period in transtrochanteric fractures? Acta Ortopédica Bras. 2022;30.
• Kollmorgen R, Umerani M, Gollon J, Fleming D, Lewis B, Harris J, et al.: Preoperative pericapsular nerve group block results in less pain, decreased narcotic use, and quicker discharge time than no block in patients who were surgically treated for femoroacetabular impingement syndrome. Arthrosc Sports Med Rehabil. 2022;4(5):e1617–21.
• Hu J, Wang Q, Hu J, Kang P, Yang J: Efficacy of Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined With Local Infiltration Analgesia on Postoperative Pain After Total Hip Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. J Arthroplasty. 2022.
• Mysore K, Sancheti SA, Howells SR, Ballah EE, Sutton JL, Uppal V: Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study. Can J Anesth Can Anesth. 2020;67:1673–4.
• Lin DY, Morrison C, Brown B, Saies AA, Pawar R, Vermeulen M, et al.: Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Reg Anesth Pain Med. 2021;46(5):398–403.
• Allard C, Pardo E, de la Jonquière C, Wyniecki A, Soulier A, Faddoul A, et al.: Comparison between femoral block and PENG block in femoral neck fractures: A cohort study. PloS One. 2021;16(6):e0252716.
• Lin DY, Brown B, Morrison C, Kroon HM, Jaarsma RL: Pericapsular nerve group block results in a longer analgesic effect and shorter time to discharge than femoral nerve block in patients after hip fracture surgery: a single-center double-blinded randomized trial. J Int Med Res. 2022;50(3):03000605221085073.
• Aliste J, Layera S, Bravo D, Jara Á, Muñoz G, Barrientos C, et al.: Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med. 2021;46(10):874–8.
• Mosaffa F, Taheri M, Rasi AM, Samadpour H, Memary E, Mirkheshti A: Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: a double-blind prospective randomized controlled clinical trial. Orthop Traumatol Surg Res. 2022;108(1):103135.
• Choi YS, Park KK, Lee B, Nam WS, Kim DH: Pericapsular Nerve Group (PENG) block versus supra-inguinal fascia iliaca compartment block for total hip arthroplasty: a randomized clinical trial. J Pers Med. 2022;12(3):408.
• Hua H, Xu Y, Jiang M, Dai X: Evaluation of pericapsular nerve group (PENG) block for analgesic effect in elderly patients with femoral neck fracture undergoing hip arthroplasty. J Healthc Eng. 2022;2022.
• Fahey A, Cripps E, Ng A, Sweeny A, Snelling PJ: Pericapsular nerve group block for hip fracture is feasible, safe and effective in the emergency department: A prospective observational comparative cohort study. Emerg Med Australas. 2022;34(6):884–91.
• Kalashetty MB, Channappagoudar R, Alwandikar V, Naik DL, Hulakund S, Guddad A: Comparison of pericapsular nerve group block with fascia iliaca compartment block in adult patients undergoing hip surgeries: A double-blinded randomized control study. Anesth Essays Res. 2022;16(3):397.
• Senthil K, Kumar P, Ramakrishnan L: Comparison of pericapsular nerve group block versus fascia iliaca compartment block as postoperative pain management in hip fracture surgeries. Anesth Essays Res. 2021;15(4):352.
• Natrajan P, Bhat RR, Remadevi R, Joseph IR, Vijayalakshmi S, Paulose TD: Comparative study to evaluate the effect of ultrasound-guided pericapsular nerve group block versus fascia Iliaca compartment block on the postoperative analgesic effect in patients undergoing surgeries for hip fracture under spinal anesthesia. Anesth Essays Res. 2021;15(3):285.
• Kong M, Tang Y, Tong F, Guo H, Zhang XL, Zhou L, et al.: The analgesic efficacy of pericapsular nerve group block in patients with intertrochanteric femur fracture: A randomized controlled trial. Plos One. 2022;17(10):e0275793.
• Sousa IP, da Silva Peixoto CL, Coimbra LF, da Costa Rodrigues F: Comparison of pericapsular nerve group (PENG) block and epidural analgesia following total hip arthroplasty: A retrospective analysis. Rev Esp Anestesiol Reanim Engl Ed. 2022;69(10):632–9.
• Fusco P, Di Carlo S, Paladini G, Scimia P, Di Martino E, Marinangeli F, et al.: Could the combination of PENG block and LIA be a useful analgesic strategy in the treatment of postoperative pain for hip replacement surgery? Reg Anesth Pain Med. 2019;44(4):531–531.
• Arango LG, Peng P. Reply to Dr Yu et al.: Inadvertent quadriceps weakness following the pericapsular nerve group (PENG) block. Reg Anesth Pain Med. 2019.
• Yeoh SR, Chou Y, Chan SM, Hou JD, Lin JA: Pericapsular nerve group block and iliopsoas plane block: a scoping review of quadriceps weakness after two proclaimed motor-sparing Hip blocks. In MDPI; 2022: 1565.

Identifiers

DOI

10.31139/chnriop.2023.88.1.3

Biblioteka Nauki

2186042