Pericapsular nerve group (PENG) block for early pain management of elderly patients with hip fracture: a single-center double-blind randomized controlled trial

Lin, Xufeng; Liu, Christopher Weiyang; Goh, Qing Yuan; Sim, Eileen Yilin; Chan, Steffi Kang Ting; Lim, Zhen Wei; Chan, Diana Xin Hui

doi:10.1136/rapm-2022-104117

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…The PENG block was effective for pain control even in the preoperative period (in the 24 h following the trauma) as a purely antalgic strategy for hip fracture patients. Xufeng et al have shown that this technique reduces the median NRS score by three points and lessens morphine use highlighting, the greater safety of this technique and suggesting that it could also be an elective technique for hip fracture patients planned for conservative treatment [49] .…”

Section: Discussionmentioning

confidence: 98%

The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study

Iacovazzo,

Sara,

Buonanno

et al. 2024

Diagnostics

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Background: An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods. Methods: We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon–Mann–Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h. Results: the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up. Conclusion: the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis.

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Section: Discussionmentioning

confidence: 98%

The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study

Iacovazzo,

Sara,

Buonanno

et al. 2024

Diagnostics

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“…The utilization of ultrasound-guided PENG block as an approach to providing perioperative analgesia to patients undergoing hip surgery is becoming increasingly common [ 9 , 10 ]. While PENG block can yield satisfactory analgesic efficacy, it also has the potential to block the function of the femoral nerve [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Volumes of Ropivacaine for Pericapsular Nerve Group Block on Incidence of Quadriceps Weakness and Analgesic Efficacy Following Hip Arthroplasty: A Randomized Controlled Trial

Wen,

Zhang,

Wang

et al. 2024

Pain Ther

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Introduction The pericapsular nerve group (PENG) block has been shown to be an effective approach to alleviating pain and reducing the need for opioids among older adults following hip surgery, with possible motor-sparing effects. No reports to date, however, have described appropriate ropivacaine volumes for use in the context of PENG block. The present prospective randomized controlled study was thus developed to assess the quadriceps muscle strength and analgesic efficacy associated with PENG block performed using three different volumes of 0.33% ropivacaine following general anesthesia in older adults undergoing hip arthroplasty. Methods In this prospective randomized double-blind controlled clinical study, 60 patients were assigned at random to undergo ultrasound-guided PENG block for hip arthroplasty using different volumes of ropivacaine. Specifically, these patients were administered 10 ml (Group A, n = 20), 20 ml (Group B, n = 20), or 30 ml (Group C, n = 20) of 0.33% ropivacaine. Quadriceps muscle strength was evaluated at 6 h post-surgery. Visual analog scale (VAS) scores at rest and with movement were assessed at 4, 6, 12, and 24 h post-surgery. Block duration, adverse event incidence, and patient satisfaction were evaluated at 24 h post-surgery. Results Quadriceps motor block incidence rates at 6 h post-surgery in the 10 ml, 20 ml, and 30 ml groups were 5%, 20%, and 75%, respectively. Quadriceps muscle weakness at 6 h post-surgery was significantly more common in the 30 ml group relative to the others ( p < 0.001). Patients administered 10 ml 0.33% ropivacaine exhibited significantly higher VAS pain scores at rest and with movement relative to those patients in the 20 ml and 30 ml treatment groups at all time points ( p < 0.05). No apparent differences in analgesic efficacy were observed when comparing the 20 ml and 30 ml groups at 4, 6, 12, and 24 h post-surgery. No significant differences in block duration, satisfaction, or adverse event incidence were observed among groups. Conclusions The preservation of motor function in the 20 ml 0.33% ropivacaine group was superior to that in the 30 ml 0.33% ropivacaine group. Relative to the group that received 10 ml 0.33% ropivacaine during PENG block, those elderly patients administered 20 ml and 30 ml volumes of 0.33% ropivacaine experienced superior postoperative pain relief following hip arthroplasty.

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“…The utilization of the PENG block in various studies has shown its superior analgesic effectiveness in lowering opioid consumption, decreasing the incidence of motor blockade, and shortening discharge time as compared to patients with no nerve block, a femoral nerve block, and an infra-inguinal fascia iliaca block with hip fractures [ 23 , 25 , 26 , 27 ]. In a single-center, double-blind, randomized controlled trial performed by Lin, Xufeng et al in Singapore General Hospital, they found that the PENG block was superior to a sham block at reducing acute traumatic pain at 30 min ( p < 0.01) and 3 h post block ( p < 0.05) and reducing opioid consumption ( p < 0.05) following hip fracture [ 28 ]. Although a PENG block is good at providing analgesia, it cannot be used as the sole anesthetic for hip surgery.…”

Section: Peripheral Nerve Blocksmentioning

confidence: 99%

Peripheral Nerve Blocks for Hip Fractures

Muse,

Deiling,

Grinman

et al. 2024

JCM

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The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block’s efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon’s perspective on nerve blocks for hip fractures.

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Pericapsular nerve group (PENG) block for early pain management of elderly patients with hip fracture: a single-center double-blind randomized controlled trial

Cited by 13 publications

References 18 publications

The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study

The Effects of the Pericapsular Nerve Group Block on Postoperative Pain in Patients with Hip Fracture: A Multicenter Study

Effects of Different Volumes of Ropivacaine for Pericapsular Nerve Group Block on Incidence of Quadriceps Weakness and Analgesic Efficacy Following Hip Arthroplasty: A Randomized Controlled Trial

Peripheral Nerve Blocks for Hip Fractures

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