Comparison of pericapsular nerve group block with fascia iliaca compartment block in adult patients undergoing hip surgeries: A double-blinded randomized control study

Abstract

Background: Hip fractures are the most common orthopedic condition in elderly patients. In this patient group, efficient preoperative analgesia that reduces the requirement for opioids and their negative side effects is crucial. This study aims for evaluating the efficiency of fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) in providing the appropriate analgesia before positioning patients for spinal anesthesia (SA). Methods: Ninety participants undergoing hip surgeries under SA were selected randomly to receive PENG block ( n = 45) using 20 mL 0.25% bupivacaine or FICB using 30 mL of 0.25% bupivacaine. The blinded observer assessed Visual Analog Scale (VAS) scores at rest, with passive leg raise to 15° before and after 30 min of the block. The blinded observer also recorded hemodynamic parameters including noninvasive blood pressure respiratory rate and heart rate. The data were analyzed using SPSS version 19. Using the appropriate statistical methodology, continuous and categorical data were analyzed, and P ≤ 0.05 was considered statistically significant. Results: At rest and with a passive leg raise to 15°, VAS scores in the PENG and FICB groups decreased significantly ( P < 0.0001). After 30 minutes of performing the PENG block, the VAS scores at rest and passive leg raise were 2.16±0.67 and 3.29±0.73 respectively, whereas with the fascia iliaca block the VAS scores at rest and passive leg raise were 4.07±0.69 and 5.11±0.71 with the p = 0.001, which is highly significant. Conclusion: PENG block outperforms fascia iliaca block in providing effective analgesia before positioning patients undergoing hip surgery under SA.

Comparison of analgesic effects of pericapsular nerve group block and fascia iliaca compartment block during hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials

“…Following the search, we initially identified 2960 studies; no additional records were found through other sources. We reviewed 984 full texts and included 12 RCTs[ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 23 ] in the analysis [ Figure 1 ]. These RCTs included 644 participants, 326 who underwent PENG block and 318 who received FICB.…”

“…[ 14 ] Two studies used ropivacaine 0.5% for both blocks[ 6 , 8 ]; however, one study used ropivacaine 0.4% for both blocks,[ 5 ] and one study used ropivacaine 0.25% for both blocks. [ 10 ] Three studies used bupivacaine 0.25% for both blocks[ 7 , 13 , 23 ]; however, one study used levobupivacaine 0.25% with dexamethasone 4 mg as an adjuvant for both blocks,[ 9 ] one study used 0.25% bupivacaine with 1 µg/kg clonidine[ 12 ] and another study used 0.375% ropivacaine. [ 11 ] The patients who were a part of the studies had ages ranging from 50 years to 74 years on average.…”

“…All of the reviewed studies evaluated postoperative pain throughout a range of times. In five studies, pain was assessed using VAS,[ 5 , 6 , 10 , 11 , 13 ] whereas the other seven used the NRS. [ 7 , 8 , 9 , 12 , 14 , 15 , 23 ] The characteristics of the included studies are shown in Table 1 .…”

“…Numerous studies demonstrated that PENG block provided a better analgesic effect than FICB. [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] Recently, one study found that PENG block may have equivalent analgesic effects to FICB[ 14 ]; however, another study found that the analgesic effect was lower with FICB at different time intervals, while no intergroup differences were seen at other time intervals. [ 15 ] These issues challenge clinicians trying to use the best evidence to guide their clinical practice.…”

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

“…For primary total hip arthroplasty, the pericapsular nerve group block results in the better preservation of the motor function than the fascia iliaca block [34]. Also, as seen in table 3, the PENG block outperformed the fascia iliaca block in providing adequate analgesia before positioning patients undergoing hip surgery under spinal anesthesia [37], which is especially important in patients undergoing hip surgery due to fracture [35].…”