Continuous pericapsular nerve group (PENG) block through an elastomeric infusion system, associated with the lateral cutaneous nerve block of the thigh for total hip arthroplasty

Costa, Amanda Oliveira da; Izolani, Guilherme Vazquez; Souza, Iorle Fabiano Monteiro de; Santiago, Bruno Vítor Martins

doi:10.1136/bcr-2021-246833

Cited by 6 publications

(6 citation statements)

References 16 publications

(13 reference statements)

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“…Among PENG block studies that reported no post-procedural quadriceps weakness or made no mention of motor function at all, clinical manifestations of extra-IP spread of local anesthetics either as observed injectate spread to the FIC in ultrasound images [ 42 ], sensory loss of dermatomes corresponding to the femoral nerve [ 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ], or an absence of statistically significant difference in quadriceps strength in patients receiving a supra-inguinal fascia iliaca compartment block (SI-FICB) [ 60 , 61 ] were found in nine case reports/series [ 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 , 51 ] and two RCTs [ 60 , 61 ] (group B). Nine case reports/series [ 1 , 48 , 52 , 54 , 55 , 56 , 57 , 64 , 66 ], one cohort study [ 60 ], and four RCTs [ 62 , 63 , 64 , 65 ] using PENG block specifically reported no motor block at all (group C).…”

Section: Resultsmentioning

confidence: 99%

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

et al. 2022

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Iliopsoas plane (IP) is a fascial plane deep to the iliopsoas complex that can serve as a potential space for the injection of local anesthetics to selectively block the articular branches of femoral nerve and accessory obturator nerve to the anterior hip capsule. Two highly similar ultrasound-guided interfascial plane blocks that target the IP, pericapsular nerve group (PENG) block and iliopsoas plane block (IPB), were both designed to achieve motor-sparing sensory block to the anterior hip capsule. However, the most recent evidence shows that PENG block can cause 25% or more of quadriceps weakness, while IPB remains the hip block that can preserve quadriceps strength. In this scoping review of quadriceps weakness after PENG block and IPB, we first performed a focused review on the complicated anatomy surrounding the anterior hip capsule. Then, we systematically searched for all currently available cadaveric and clinical studies utilizing PENG block and IPB, with a focus on quadriceps weakness and its potential mechanism from the perspectives of fascial plane spread along and outside of the IP. We conclude that quadriceps weakness after PENG block, which places its needle tip directly deep to iliopsoas tendon (IT), may be the result of iliopectineal bursal injection. The incidental bursal injection, which can be observed on ultrasound as a medial fascial plane spread, can cause bursal rupture/puncture and an anteromedial extra-IP spread to involve the femoral nerve proper within fascia iliaca compartment (FIC). In comparison, IPB places its needle tip lateral to IT and injects just one-fourth of the volume of PENG block. The current evidence, albeit still limited, supports IPB as the true motor-sparing hip block. To avoid quadriceps weakness after PENG block, a more laterally placed needle tip, away from the undersurface of IT, and a reduction in injection volume should be considered. Future studies should focus on comparing the analgesic effects and quadriceps function impairment between PENG block and IPB.

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Section: Resultsmentioning

confidence: 99%

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

et al. 2022

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“…The use of an indwelling catheter was described with a low-volume bolus and infusion pump. [ 5 , 6 ] We had placed a catheter in one patient at 2 mL/h for 5 days as the patient was admitted in the hospital for analgesic titration and was subsequently discharged on 2nd day. The patient had good pain relief and no untoward complications.…”

Section: Discussionmentioning

confidence: 99%

Pericapsular Nerve Group Block as an Effective Intervention for Pain Relief and Improving Functional Mobility in Cancer Patients: A Case Series

Mantha,

Suvvari,

Kodisharapu

et al. 2023

IJPC

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Pericapsular nerve group block (PENG) is an ultrasound-guided regional block technique that blocks the articular branches of the femoral nerve, accessory obturator nerve and obturator nerve. These nerves richly innervate the anterior capsule of the hip joint and blocking these nerves helps in hip analgesia. PENG block is commonly used in hip fracture pain perioperatively. In this case series, we have used PENG block in cancer patients with hip pain. PENG block was given to six patients with bupivacaine and triamcinolone, out of which five patients had good pain relief and their functional mobility to activities of daily living improved.

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“…Da Costa et al (23), described a case report for analgesia delivered through a continuous infusion via a catheter inserted in the iliopsoas muscle and the iliopubic eminence, for total hip arthroplasty. The study showed that the continuous PENG block via a catheter with an elastomeric pump for 48 hours, plus the femoral cutaneous single dose block, provides an adequate level of analgesia.…”

Section: Observational Studiesmentioning

confidence: 99%

¿Qué conocemos del bloqueo PENG para cirugía de cadera? Una revisión narrativa

De Santis,

Suhr,

Irizaga

2024

Colomb. J. Anesthesiol.

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Postoperative pain management in hip surgery is classified as severe and its inadequate control leads to complications that increase patient morbidity and mortality. The PENG block is advocated as a safe, opioid-sparing analgesic technique, which provides an adequate level of analgesia. The purpose of this study is to analyze and reflect about the efficacy, safety and therapeutic appropriateness of the PENG block in hip surgery. To this end, a narrative review is conducted using various databases such as PubMed and the Cochrane library. In all of the studies analyzed, an adequate postoperative pain control was achieved using the PENG block, with reduction in pain assessment scales and opioid consumption in the first postoperative hours. Improved results were also seen as compared with other regional blocks. There were few adverse effects and none of them was classified as severe. The PENG block contributes with numerous advantages and few adverse effects for hip surgery. Further studies are needed on this block, whether alone or in combination with other regional techniques, so as to include it in analgesia protocols, developing a standardized approach and study the outcomes in more controlled settings.

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Continuous pericapsular nerve group (PENG) block through an elastomeric infusion system, associated with the lateral cutaneous nerve block of the thigh for total hip arthroplasty

Cited by 6 publications

References 16 publications

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

Pericapsular Nerve Group Block as an Effective Intervention for Pain Relief and Improving Functional Mobility in Cancer Patients: A Case Series

¿Qué conocemos del bloqueo PENG para cirugía de cadera? Una revisión narrativa

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