A Retrospective Case Series of Pericapsular Nerve Group (PENG) Block for Primary Versus Revision Total Hip Arthroplasty Analgesia

Abstract

The innervation of the hip joint is complex and it is challenging to provide effective analgesia after hip surgery utilizing any single regional anesthesia technique. The pericapsular nerve group (PENG) block is an interfascial plane block aiming to block articular branches supplied by femoral, obturator, and accessory obturator nerves. In this case series, we compare the efficacy of the PENG block to provide analgesia in primary and revision total hip arthroplasty (THA). The ultrasound-guided PENG block technique is described and post-operative pain scores and opioid requirements are reported. The PENG block was successfully used in primary THA as a solo block, and it may be used in combination with other regional blocks for any hip surgery. The PENG block is an easy regional technique to perform in the supine position with motorsparing benefits.

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

“…To calculate sample size, we considered our primary hypothesis, that postoperative analgesia is improved with the PENG block. Although there were no similar clinical trials, we estimated the density of pain scores as mean 2 and SD 1.5, based on published data regarding the use of PENG block for total hip arthroplasty[17,18]. To simulate power, we used the truncated Gaussian distribution with range 0-10, SD 1.5 and PENG group mean of 2.…”

Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series

“…The results of the lumbar ESPB single injection in this case series for hip analgesia are comparable to the fascia iliaca block and to PENG blog, with a pain reduction from severe to mild, following a single injection. (23,24) It should be highlighted that though in most patients in this series severe pain was observed after 24 hours, the single injection Tulgar technique block is a valuable therapeutic option in institutions that don't have a pain unit for proper assessment and surveillance of these catheters. This statement is supported by cases reporting up to 36 hours of analgesia following single injection blocks.…”

Pericapsular Nerve Group (PENG) Block in Combination With the Quadratus Lumborum Block Analgesia for Revision Total Hip Arthroplasty: A Retrospective Case Series

“…In a recent case series utilizing PENG block for THA, postoperative pain scores and OME use were lower in the group undergoing primary hip surgery compared to revisions [ 1 ]. This reveals that PENG blocks may be a useful regional anesthetic technique for postoperative analgesia for primary hip surgery.…”

“…Given the prevalence of osteoarthritis amongst the increasingly aging population and subsequent need for total hip arthroplasty, the frequency of revision hip surgeries is expected to rise. It is estimated that more than 2.5 million patients in the United States alone have had a total hip arthroplasty (THA) [ 1 ]. Revisions become necessary for a variety of reasons: failed implant whether from wear or loosening, infections, recall of prosthesis.…”