Reply to Aydin et al.: A Novel Indication of Pericapsular Nerve Group Block: Surgical Anesthesia for Vein Ligation and Stripping

Girón-Arango, Laura; Tran, John; Peng, Philip

doi:10.1053/j.jvca.2019.10.027

Cited by 19 publications

(20 citation statements)

References 6 publications

(9 reference statements)

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“…However, the quadriceps strength was not quantitatively measured using a dynamometer. Although superficial or medial local anesthetic injection of the target anatomical location while performing the PENG block was considered to lead to unexpected motor blockade [ 24 , 25 ], there was no serious difficulty in needle placement using PENG block in this study. Aliste et al performed supra-inguinal FICB with 40 mL levobupivacaine 0.25% [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Choi

Park

Lee

et al. 2022

JPM

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This study compared the effects of the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on postoperative analgesia and quadriceps strength following total hip arthroplasty under general anesthesia. A total of 58 patients were randomized to receive either PENG block (PENG group) or supra-inguinal FICB (FICB group) following anesthetic induction. The primary outcomes were the postoperative pain scores. Patients were randomized to receive either PENG block or supra-inguinal FICB following anesthetic induction. Pain scores at rest and with movement were assessed preoperatively, at the postanesthesia care unit (only at rest), and at 6, 24, 36, and 48 h postoperatively. Opioid consumption was also assessed for 48 h postoperatively. Quadriceps strength measurements were performed preoperatively, at 6, 24, and 36 h postoperatively. In total, 54 patients completed the study: 27 in the PENG group and 27 in the FICB group. Despite lower pain scores at rest in the PENG group at postoperative 6 and 24 h, there were no significant differences in the pain scores at rest and during movement between the two groups during postoperative 48 h in the linear mixed model analysis (p = 0.079 and p = 0.323, respectively). Cumulative opioid consumption up to postoperative 48 h was also similar in the two groups (p = 0.265). The changes in quadriceps strength measurements in the operative leg and the nonoperative leg were not significantly different between the groups (p = 0.513 and p = 0.523, respectively). The PENG block may have similar analgesic efficacy to the supra-inguinal FICB. No difference was detected in the quadriceps strength between the patients receiving these two blocks.

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Section: Discussionmentioning

confidence: 99%

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Choi

Park

Lee

et al. 2022

JPM

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“…However, the PENG block will not relieve the pain related to the skin incision and subcutaneous dissection which is covered by the lateral cutaneous nerve. A combination of the LFCN block to PENG block was suggested to give a better form of analgesia than PENG block alone [38,39]. The scope of this study was to evaluate the preoperative analgesic effect of PENG block during positioning for anesthesia before the start of the skin incision.…”

Section: Discussionmentioning

confidence: 99%

Pericapsular nerve group block for analgesia of positioning pain during spinal anesthesia in hip fracture patients, a randomized controlled study

Alrefaey

Abouelela

2020

Egyptian Journal of Anaesthesia

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“…They found that 10 mL of dye injected into the fascial plane between IT and iliac corpus could stain the entire anterior hip capsule with minor cranial extension into the pelvis ( Figure 4 a) [ 22 ]. In comparison, 20 mL of dye injected into the same plane on the other side produced more extensive intrapelvic spread cranially up to the level of the ASIS and medially into the lesser pelvis [ 22 ] ( Figure 5 b), potentially reaching the obturator groove to involve the obturator nerve proper intrapelvically [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most commonly speculated mechanisms of quadriceps weakness after PENG block is the anteromedial spread of local anesthetics along the surface of PM to capture femoral nerve proper within FIC [ 67 ]. It has been argued that this anteromedial spread occurs from a needle tip placed either too superficially (intramuscular injection) or too medially relative to IT [ 2 , 18 , 67 ].…”

Section: Discussionmentioning

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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Reply to Aydin et al.: A Novel Indication of Pericapsular Nerve Group Block: Surgical Anesthesia for Vein Ligation and Stripping

Cited by 19 publications

References 6 publications

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Pericapsular nerve group block for analgesia of positioning pain during spinal anesthesia in hip fracture patients, a randomized controlled study

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

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