Effectiveness of Pericapsular Nerve Group Block with Ultrasonography in Patients Diagnosed with Hip Fracture in the Emergency Department

Abstract

BACKGROUND: Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplasties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department. METHODS: This single-center, randomized, and prospective study was carried out in the emergency department. The patients included in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization. RESULTS: Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thirteen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30 th min, 2 nd , 6 th , and 24 th h were 1.78±1.83, 0.00±0.00, 0.00±0.00, and 1.28±1.41 in the PENG group. On the other hand, it was 3.38±1.86, 0.05±0.22, 2.86±2.37, and 4.95±1.47 in the control group, respectively. The mean NRS scores of the patients at 15° elevation of the leg at the 30 th min, 2 nd , 6 th , and 24 th h were 3.06±1.80, 0.06±0.24, 0.22±0.43, and 2.44±1.50 in the PENG group and it was 5.24±1.81, 1.05±0.92, 4.29±2.35, and 7.14±1.24 in the control group, respectively. CONCLUSION: PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF.

Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis

“…Based on the Cochrane risk of the bias assessment tool, the quality of the included studies ranged from low to high quality with seven studies of low quality [15][16][17][18][19][20][21]; two of moderate quality [22,23]; and six high-quality studies [24][25][26][27][28][29]. Risk of bias graph and summary of quality assessment domains of included studies are shown in Figs.…”

“…We updated our search in August 2022 retrieving a total of 180 records. After screening and applying eligibility criteria, one study [ 15 ] was found to be eligible. Reasons for the exclusion of full-text articles are shown in the online resource (Table S2).…”

“…However, the clinical efficacy All clinical trials retrieved from our literature search used PENG block technique for analgesia of hip fracture patients except one [21] used it for patients undergoing hip arthroscopy to perform femoroplasty, labral repair, and reconstruction. All studies included used PENG block technique for scheduled elective surgeries except five: one study [15] used it for emergency cases and four studies [16,18,20,24] did not report any data on that point. Studies included were highly different in terms of the time of intervention, main indication, and volume of injectate.…”

“…Studies included were highly different in terms of the time of intervention, main indication, and volume of injectate. Regarding the time of intervention and main indication; five studies [ 17 , 18 , 24 , 26 , 27 ] used PENG technique to position patients for spinal anesthesia in addition to post-operative pain control; seven studies [ 19 – 23 , 25 , 29 ] used it preoperatively for post-operative pain control; two [ 16 , 28 ] used it postoperatively for pain management; and one study [ 15 ] used it for analgesia in the emergency department with no association to the operation time. Regarding the dose of injectate; all studies reported using 20 ml of volume injectate to perform PENG block except six studies; three of them [ 19 , 21 , 28 ] used 30 ml; and one [ 26 ] used 25 ml of volume.…”

“…In another scenario, we excluded studies with a high risk of bias [15,16,[18][19][20][21]. The overall SMD did not change significantly (SMD -0.59; 95% CI [-0.79 to -0.39]; p > 0.00001; low grade of evidence; Fig.…”