Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial

Abstract

BackgroundThe femoral nerve block (FNB) may be used for analgesia in hip fracture surgery. The pericapsular nerve group (PENG) block is a novel regional technique and may provide better pain reduction while preserving motor function, but these blocks have not been directly compared.MethodsIn a single-center double-blinded randomized comparative trial, patients presenting for hip fracture surgery received analgesia with either FNB or PENG block. The primary outcome measure was pain scores (Numeric Rating Scale (NRS) 0 to 10). Secondary outcomes were postoperative quadriceps strength, opiate use, complications, length of hospital stay, and patient-reported outcomes.ResultsSixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperatively in recovery (day 0), the PENG group experienced less pain compared with the FNB group. (In the PENG group, 63% experienced no pain, 27% mild pain, and 10% moderate to severe pain. In comparison, 30% of the FNB group reported no pain, 27% mild pain, and 36% moderate to severe pain; p=0.04). This was assessed using an 11-point Likert NRS. Quadriceps strength was better preserved in the PENG group in the recovery unit (assessed using Oxford muscle strength grading, 60% intact in the PENG group vs none intact in the FNB group; p<0.001) and on day 1 (90% intact vs 50%, respectively; p=0.004). There was no difference in other outcomes.ConclusionsPatients receiving a PENG block for intraoperative and postoperative analgesia during hip fracture surgery experience less postoperative pain in the recovery room with no difference detected by postoperative day 1. Quadriceps strength was better preserved with the PENG block. Despite the short-term analgesic benefit and improved quadriceps strength, there were no differences detected in the quality of recovery.

Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer‐masked, controlled trial

“…The pericapsular nerve group (PENG) block is an ultrasound-guided approach, first described by Giron-Arango et al for the blockade of the articular branches of the femoral, obturator and accessory obturator nerves that provide sensory innervation to the anterior hip capsule [9,10]. It has been successfully used as an alternative regional anaesthesia technique for the management of acute pain after hip fracture [11,12], but its applications are expanding, suggesting a potential role for analgesia after elective hip surgery [13,14].…”

Pericapsular nerve group block results in a longer analgesic effect and shorter time to discharge than femoral nerve block in patients after hip fracture surgery: a single-center double-blinded randomized trial

“…Research on the PENG block has been limited to a small number of randomized controlled trials and letters to the editor. 3 , 7 – 9 While all studies have reported similar findings of improved analgesia and increased preservation of quadriceps strength, much remains unknown about this new regional technique, such as the block duration, minimum effective volume for dosing, patient-related outcome measures, and effect on health economics. This further analysis was aimed to provide clarity regarding the block duration and length of time to hospital discharge readiness.…”

“…The sample size calculation is described in the primary publication. 3 The a priori power calculation was performed using PASS V.14 software (NCSS LLC, Kaysville, UT, USA) on the basis of the pain score reduction as the primary outcome in our previous analysis. This analysis showed mean reductions of 3.4 points after FNB and 7 points after PENG block (both out of 10) on day 0 postoperatively (standard deviation (SD) 2).…”

The Tissue Plane

“…The Tissue Plane DOI: http://dx.doi.org/10.5772/intechopen.99533 reports and recently a randomised controlled study in the hip fracture population [101]. Whilst it appears remarkably effective for analgesia for hip fractures, the reasons for this are yet to be fully answered.…”