A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block

Luftig, Josh; Dreyfuss, Andrea; Mantuani, Daniel; Howell, Kaitlen; White, Angela; Nagdev, Arun

doi:10.1016/j.ajem.2020.05.085

Cited by 26 publications

(34 citation statements)

References 19 publications

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“…Vaginal nerve blocks block the transmission of perineal pain, allowing pelvic floor muscle tissue to relax completely. It can not only relieve labor pain but also reduce the resistance of fetal delivery, shorten the time of the second stage of labor, and have no effect on uterine autonomic nerve and uterine contractions [6].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Zhang

Xiao-ying

Zhao

et al. 2021

Scientific Programming

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This work was aimed to study the analgesic effect of pudendal nerve block on obstetrics and gynecology under the guidance of ultrasound image based on optimized fast super resolution reconstructed convolutional neural network (FSRCNN) algorithm. A total of 110 primiparas from hospital who gave birth through vagina were randomly rolled into experimental group (55 cases) and control group (55 cases). The optimized FSRCNN algorithm was constructed, compared with the FSRCNN algorithm and the Bicubic algorithm and applied to 110 cases of maternal patients undergoing perineotomy under ultrasound image-guided pudendal nerve block. Visual analogue scoring (VAS), incision suture pain VAS score, occurrence of complications, puerpera labor time, and newborn weight were recorded and compared, so did Apgar score of newborns, numbness of maternal thigh, recovery of puncture site, and satisfaction of maternal analgesia. The results showed that the peak signal-to-noise ratio (PSNR) of the high-resolution image reconstructed by the FSRCNN algorithm was 32.68 dB and that reconstructed by the optimized FSRCNN algorithm was 32.19 dB. The PSNR of the Bicubic algorithm processed image was 28.51 dB. In the lateral resection of episiotomy in the second stage of labor, the visual analog score (2.3 ± 1.5 points) of the experimental group was inferior to that of the control group (7.1 ± 2.6 points) ( P < 0.05 ). The visual analogue score of stitch pain (1.3 ± 0.8 points) was also inferior to that of the control group (5.2 ± 1.9 points) ( P < 0.05 ). Moreover, the satisfaction of the parturients in the experimental group (9.86 ± 0.41 points) was considerably superior to that of the control group (7.36 ± 1.25 points) ( P < 0.05 ). In short, the optimized FSRCNN algorithm had a short training time and good reconstruction effect. Ultrasound-guided pudendal nerve block had a substantial analgesic effect on the second stage of labor and improved parturients’ satisfaction.

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Section: Introductionmentioning

confidence: 99%

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Zhang

Xiao-ying

Zhao

et al. 2021

Scientific Programming

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“…The spread to ON was also supported in the view of the shorter course of the so-called barrier iliopectineal fascia in the cranio-caudal direction (Ahiskalioglu et al, 2020a ). With the injection of a higher volume of the drug, PENG block has reportedly shown efficacy in acetabular and pelvic fracture, which may be due to the possibility of working as a hematoma block and spread of drug along the bone surface leading to sensory anaesthesia of the bone (Luftig et al, 2020 ). In the view of smaller potential space between iliopsoas eminence and psoas tendon, administration of higher volume of drug is believed to have leaked through deeper plane between the pectineus and the psoas to FN in the superficial plane (Giron Arango & Peng, 2019 ; Singh, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

“…Local anaesthetics like bupivacaine, lidocaine, levobupivacaine, ropivacaine, and mepivacaine have all been used successfully in different concentrations, alone as well as in combination (Girón-Arango et al, 2018 ; Jadon et al, 2020a , b ; Pagano et al, 2019 ; Aydin et al, 2020 ). Some researchers have also added dexamethasone and epinephrine to local anaesthetic (Luftig et al, 2020 ; Girón-Arango et al, 2018 ; Yu et al, 2019 ; Fusco et al, 2019 ; Orozco et al, 2019 ; Acharya & Lamsal, 2020 ; Wyatt et al, 2020a , b ; Sandri et al, 2020 ; Fusco et al, 2020a , b ; Mysore et al, 2020 ; Talawar et al, 2020 ; Ayub et al, 2020 ). Index description used 20 ml volume in the block and the use of a similar volume is reported in most of the subsequent publications (Girón-Arango et al, 2018 ).…”

Section: Resultsmentioning

confidence: 99%

“…Index description used 20 ml volume in the block and the use of a similar volume is reported in most of the subsequent publications (Girón-Arango et al, 2018 ). However, some used 10 ml and others preferred using a higher volume of 30 ml and 40 ml (Luftig et al, 2020 ; Ahiskalioglu et al, 2020a ; Singh, 2021 ; Bilal et al, 2020 ; Aydin et al, 2020 ; Ayub et al, 2020 ; Romero et al, 2019 ; Remily et al, 2020 ; Ahiskalioglu et al, 2020a ; Ahiskalioglu et al, 2020b ). Speculating the potential space between the iliopsoas eminence and the psoas tendon to be small, Singh successfully used 10 ml volume while using the continuous technique with the intention to administer just enough volume for successful sensory block while avoiding chances of inadvertent motor block (Singh, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

“…Pelvic fracture and surgery of the hip are very painful (Luftig et al, 2020 ). Less invasive peripheral nerve blocks including fascia iliaca compartment block (FIB) and femoral nerve (FN) block have shown considerable advantages as an analgesic modality and are being preferred in the analgesic and anaesthetic management of hip pathologies (Girón-Arango et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Pericapsular nervegroup (PENG) block—a scoping review

Kaur

Saikia

Dey

et al. 2022

Ain-Shams J Anesthesiol

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The obturator nerve and its accessory branch supplying the hip region, unlike the femoral nerve, are not adequately anaesthetized by conventional regional anaesthetic techniques targeting the hip region. With advancements in ultrasound-guided regional anaesthetic techniques, interests are revived in the field and efforts are being made to block them together. One such successful attempt is the novel peri-capsular nerve group (PENG) block. Consequently, further research on the PENG block began to explore its versatilities. The present study undertakes a scoping review of research on the PENG block in humans for any indication to determine the extent of the research done, the methodologies used, and other practical issues addressed in the research. This will help to identify potential research gaps that should be addressed in the future. PubMed, Google Scholar, Cochrane Library, KoreaMed, Latin American and Caribbean Health Science Literature, and the directory of open access journals were searched with the keyword “PENG block” and “pericapsular nerve group”. Manual search of electronically retrieved papers was also carried out. Among the 67 articles selected in our review, eighteen are case series; twenty-nine are case reports; two are randomized studies; one each of prospective cohort study, review, and cadaveric study; and 15 are editorials. However, only 64 articles were included later due to the retraction of three case reports. Data is insufficient to provide firm recommendations for or against different aspects of the block. The review encourages future work addressing different aspects of the PENG block.

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Point‐of‐care ultrasound‐guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report

Cripps

Fahey

Snelling

2022

Australas J Ultrason Med

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Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard‐volume point‐of‐care ultrasound‐guided pericapsular nerve group (PENG) block performed in the emergency department. The standard‐volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.

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A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block

Cited by 26 publications

References 19 publications

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Ultrasound Image-Guided Pudendal Nerve Block on Analgesic Effect of Perineotomy under Optimized Fast Super Resolution Reconstructed Convolutional Neural Network Algorithm

Pericapsular nervegroup (PENG) block—a scoping review

Point‐of‐care ultrasound‐guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report

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