Analgesic evaluation of ultrasound-guided Pericapsular Nerve Group (PENG) block for emergency hip surgery in fragile patients: a case series

Abstract

Background: Emergency hip surgery is common especially in elderly patients. Very often we are faced with elderly and fragile patients with several comorbidities. In these cases a careful pain control is crucial to reduce length of stay, costs, postoperative complications and mortality. Currently the Fascia Iliaca Block (FIB) and the Femoral Nerve Block (FNB) are the main techniques used for this purpose. Cases presentation: Recently, a new method has been described under ultrasound-guidance, the Pericapsular Nerve Group (PENG) block. In this case series we try to point out the importance of this novel, safe and effective ultrasound-guided locoregional analgesic technique as an alternative to FIB or FNB based on our clinical experience. Conclusion: In this case series the PENG block has been proved to be safe and effective, but more and larger-sized studies are needed to better assess the method in future before it becomes an established analgesic technique for hip surgery.

Pericapsular nervegroup (PENG) block—a scoping review

“…The PENG block, like other regional anaesthetic techniques may offer effective perioperative analgesia (can be prolonged with the use of longer acting local anaesthetic, adjuvants, and catheter placement) and simultaneously reduce the requirement of opioids and related effects like nausea, vomiting, delirium, etc. (Girón-Arango et al, 2018 ; Pagano et al, 2019 ; Singh, 2021 ; Ayub et al, 2020 ). Being a primary sensory block, it may facilitate early mobilization and recovery, unlike other nerve blocks (Luftig et al, 2020 ; Yu et al, 2019 ; Pagano et al, 2019 ).…”

“…Numerous explanations have been proposed about the dissemination of the drug in the block. After injection into the target area (mainly involving articular branches of FN and AON) as in the initial description, spread to the subpectineal plane (containing articular branches of ON) is hypothesized to be by following the ilio-infratrochanteric muscular bundle throughout the “lacuna musculorum”(Girón-Arango et al, 2018 ;Pagano et al, 2019 ; Giron Arango & Peng, 2019 ; Nielsen et al, 2017 ; Fusco et al, 2019 ). 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 ).…”

“…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 ).…”

“…(Girón-Arango et al, 2018 ; Pagano et al, 2019 ; Singh, 2021 ; Ayub et al, 2020 ). Being a primary sensory block, it may facilitate early mobilization and recovery, unlike other nerve blocks (Luftig et al, 2020 ; Yu et al, 2019 ; Pagano et al, 2019 ). Authors believe it to be comparatively safer in patients with comorbidity (Ahiskalioglu et al, 2020a ; Dangle et al, 2020 ; Fusco et al, 2020a , b ; Kukreja et al, 2020a , b ).…”

Bloqueo de Pericapsular Nerve Group en cirugía de cadera. Experiencia analgésica perioperatoria

“…Los resultados obtenidos durante la realización de este trabajo son similares a los reportados en la bibliografía consultada. 8 La utilización del bloqueo de PENG durante el perioperatorio se tradujo en una disminución promedio en escala de ENA en reposo de 5.2 puntos 20 minutos después de la administración del bloqueo, 5.6 puntos a las cuatro horas después de la cirugía y 4.9 puntos 10 horas después de finalizada la cirugía con un valor basal reportado de 6.9 puntos en promedio, 9 y de 6, 5.9 y 4.8 (basal 8.6) puntos a la movilización en los mismos tiempos que en reposo, lo cual es similar a los estudios reportados. La duración de la analgesia (evaluada hasta las 10 horas postquirúrgicas) también es similar a lo reportado, manteniendo adecuado estado de confort y permitiendo tanto la deambulación como el inicio temprano de los protocolos de rehabilitación.…”