Iliopsoas plane block for postoperative analgesia after total hip replacement

Wang, Chunguang; Yang, Ming-Yu; Yang, Yang; Ma, Fengdan; Jiang, Bowei

doi:10.23736/s0375-9393.22.16374-1

Cited by 5 publications

(7 citation statements)

References 7 publications

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“…Among the cadaveric studies, there are four articles on PENG block [ 22 , 37 , 38 , 39 ] and one on IPB [ 8 ]. All clinical studies except one randomized controlled trial (RCT) [ 7 ] and two recently published case series [ 40 , 41 ] utilized PENG block.…”

Section: Resultsmentioning

confidence: 99%

“…Among clinical studies utilizing IPB ( n = 3), the volunteer RCT [ 7 ] reported no statistically significant post-procedural quadriceps weakness, but there was radiologic evidence of minor injectate spread into the FIC (group B). The two most recent case series using IPB [ 40 , 41 ] reported no post-procedural motor block at all (group C). The complete list of included studies and their characteristics are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Just recently, two case series that adopted IPB for the first time in patients receiving hip surgeries were published. A 10 mL IPB was performed pre-operatively to look for its analgesic effects and side effects in quadriceps involvement, and their results supported IPB’s claim as an effective sensory block to hip that is also motor-sparing [ 40 , 41 ]. Nonetheless, higher-quality clinical studies, especially ones with a head-to-head comparison with PENG block, are needed for IPB.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…No significant difference in pain level has been observed in both groups. 31 Taken together, all of the aforementioned studies demonstrated the positive role of TEAS in alleviating pain after surgery and reducing drug doses. Table 3 presents a summary of RCTs assessing the effectiveness of TEAS in pain alleviation.…”

Section: Nv Induced By Intravenous Analgesia With Tramadolmentioning

confidence: 88%

Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review

Szmit¹,

Krajewski²,

Rudnicki³

et al. 2023

Adv Clin Exp Med

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Transcutaneous electrical acupoint stimulation (TEAS) is an emerging therapeutic approach that combines the effects of transcutaneous electrical nerve stimulation (TENS) with acupuncture point stimulation. Due to its noninvasive nature, it possesses relative advantages over traditional acupuncture and needle-based electrostimulation. Despite the large number of randomized clinical trials (RCTs) describing the effectiveness of TEAS in different applications, its role and mechanism are still not fully understood. The aim of this study was to systematically compare and summarize the latest studies examining a variety of TEAS applications in clinical practice. Databases, including Medline (PubMed), Cochrane Library and Google Scholar were searched without any time restrictions (as of March 2021). The analysis was performed according to the Cochrane Collaboration criteria. Out of 637 studies, only 22 RCTs were selected. Nine studies evaluated the impact of TEAS on nausea and vomiting (NV), showing beneficial effects compared to standard therapy. Eight RCTs examined the effectiveness of TEAS in pain management, reporting pain alleviation described using the visual analog scale (VAS) and lowering of total opioid doses. Improvement of postoperative recovery, in vitro fertilization and pregnancy outcomes, as well as display of cardioprotective properties were found to positively correlate with TEAS. As a noninvasive modality with advantages over classical acupuncture and needle-based electrostimulation, TEAS may be a valuable tool in clinical practice, particularly for pain and NV management. However, considering the methodological quality of the RCTs, rigorous large-scale clinical trials are required to evaluate the clinical utility of this method.

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“…In a cadaver model, a low volume (5 ml) injection stained 10 out of 15 cadaver's femoral branches along the iliopsoas plane without evidence of staining of motor branches [20]. In a clinical study following IPB in THA, Wang et al [22] found better postoperative pain scores with hip flexion and improved quadriceps strength with manual muscle testing. Within hip fracture, IPB use decreased pain scores up to postoperative 48 h [23 ▪▪ ].…”

Section: Iliopsoas Plane Blockmentioning

confidence: 99%

Motor-sparing peripheral nerve blocks for hip and knee surgery

Restrepo-Holguin,

Kopp,

Johnson

2023

Current Opinion in Anaesthesiology

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Purpose of review To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. Recent findings Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation. Summary The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.

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Iliopsoas plane block for postoperative analgesia after total hip replacement

Cited by 5 publications

References 7 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

Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice: A systematic review

Motor-sparing peripheral nerve blocks for hip and knee surgery

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