The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial

Lin, D-Yin; Brown, Brigid; Morrison, Craig; Fraser, Nikolai S.; Chooi, Cheryl; Cehic, Matthew G.; McLeod, David H.; Henningsen, Michael D.; Sladojevic, Nikolina; Kroon, Hidde M.; Jaarsma, Ruurd L.

doi:10.1186/s12871-022-01787-2

Cited by 32 publications

(61 citation statements)

References 31 publications

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“…In the present research, the quadriceps muscle strength was similar between the PENG block group and the sham block group after surgery, and the ranges of quadriceps muscle activity and "time to first walk" were even significantly better in the PENG group (8,9,29). The exercise retention effect enables patients to move early after surgery, which in itself is associated with fewer complications, shorter hospital stays, and lower mortality (30,31).…”

Section: Discussionsupporting

confidence: 51%

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Shen²,

Li³

2023

Front. Med.

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BackgroundAs an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery.MethodsA total of 497 academic articles were identified after a systematic search in the databases of PubMed, Embase, Web of Science, and Cochrane Library up to 25 August 2022. The primary outcome was postoperative 24-h morphine consumption. Secondary outcomes included the time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and incidence of postoperative nausea and vomiting (PONV). We calculated mean differences (MDs) with 95% confidence intervals (CIs) for postoperative 24-h morphine consumption, time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and odds ratios (ORs) with 95% CIs for incidence of PONV. The chi-square test was used for heterogeneity analysis, and heterogeneity was assessed by I2. Statistical analysis was performed using Review Manager 5.4.ResultsNumerous electronic databases were searched, and finally, nine studies were identified. There was no significant difference in morphine consumption during the postoperative 24 h [MD: −2.57, 95% CI: (−5.42, 0.27), P = 0.08] and the time of the first request for rescue analgesia [MD: 1.79, 95% CI: (−1.06, 4.64), P = 0.22] between the PENG block and control groups. PENG block did not reveal a significant difference in 6 h [MD: −0.17, 95% CI: (−0.92, 0.57), P = 0.65] [MD: −0.69, 95% CI: (−1.58, 0.21), P = 0.13] and 24 h [MD: −0.25, 95% CI: (−1.54, 1.05), P = 0.71], [MD: 0.05, 95% CI: (−0.84, 0.93), P = 0.91] static and dynamic pain scores compared with other nerve block methods. Moreover, the two groups have a similar risk of PONV (OR: 1.29, 95% CI = 0.53–3.10, P = 0.57).ConclusionThis review shows that PENG block can act as an alternative multimodal analgesia for hip surgery, and compared with the other kinds of nerve block, there was no significant difference in the postoperative analgesic effect of PENG block.Systematic review registrationSupplementary Datasheet 1, identifier: CRD 42022356496.

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Section: Discussionsupporting

confidence: 51%

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

Shen²,

Li³

2023

Front. Med.

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“…The complete text of the remaining 21 articles was read to determine eligibility. Sixteen additional articles were then excluded due to reasons listed as follows: they were reviews or case reports ( n = 6) [ 14 – 19 ] or retrospective studies ( n = 3) [ 20 – 22 ], or the comparison was with other forms of nerve block, and not FICB ( n = 4) [ 23 – 26 ], or the comparison was with placebo ( n = 3) [ 27 – 29 ]. Finally, five studies [ 10 – 12 , 30 , 31 ] were selected for our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis

Wang

Wen

2022

Pain Ther

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Introduction Patients with hip surgery often experience moderate to severe postoperative pain, and need large doses of opioids to relieve it, which is not conducive to patient rehabilitation. Pericapsular nerve group (PENG) block is a new regional block technique that is considered to reduce postoperative pain and the use of opioids. The purpose of this study was to evaluate the efficacy and safety of PENG block for postoperative analgesia after hip surgery. Methods We searched multiple databases for randomized controlled trials (RCTs) published in English, which compared PENG block with fascia iliaca compartment block (FICB). The primary outcome was 24 h postsurgical opioid consumption (OC). The secondary outcomes were pain scores (PSs) at different timepoints after surgery and the incidence of postoperative nausea and vomiting (PONV). Results Five RCTs involving 234 patients were selected for our analysis. Our results show that the 24 h OC was drastically lower in PENG block versus FICB patients (SMD −0.60, 95% CI −1.08 to −0.11); P < 0.05, I 2 = 69%). At the same time, there were no significant difference in postsurgical PSs between the two cohorts (6 h: MD −0.07, 95% CI −0.67 to 0.53; P = 0.82, I 2 = 43%; 12 h: MD −0.60, 95% CI −1.40 to 0.19; P = 0.14, I 2 = 31%; 24 h: MD 0.17, 95% CI −0.87 to 1.21; P = 0.75, I 2 = 76%; 36 h: MD 0.80, 95% CI −0.92 to 2.51; P = 0.36, I 2 = 73%; 48 h: MD −0.06, 95% CI −0.75 to 0.63; P = 0.86, I 2 = 0%) and the incidence of PONV (RR 1.00, 95% CI 0.40–2.50, P = 1.00, I 2 = 35%). Conclusions Our research shows that PENG block can reduce the use of opioids after hip surgery and is effective in postoperative analgesia. Future research should explore the injection method, concentration, and dosage.

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“…Zheng et al 2022 [23] and Lin et al 2022 [24] found no significant variance among total hip arthroplasty patients who had an intra-articular local anaesthetic injection and those who received a placebo injection (20 ml saline) when they compared the two methods. Cases in the PENG group had noticeably lower pain levels than those in the control group during recuperation, however this difference disappeared after patients were sent home.…”

Section: Discussionmentioning

confidence: 99%

The effect of preoperative ultrasound-guided peri-capsular nerve group block (PENG) on the postoperative analgesia after total hip arthroplasty: A randomized controlled study

Elnefiawy¹,

Abdelwahed²,

Ahmed³

et al. 2023

Int. J. Med. Anesthesiology

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Background: Pain can range from moderate to severe after total hip arthroplasty, a routine surgical procedure. The functional recovery and long-term functional result of a surgical patient depend on early ambulation and physical therapy. Hence, the primary goal of postoperative pain management following THA continues to be providing for maximal pain relief while safeguarding motor function. Patients and Methods: Sixty adult cases were part of this prospective randomised double-blind controlled trial at Tanta University Hospitals from August 2021 to June 2022. Patients were randomly allocated according to technique used into two groups. Group I (control group): Received sham PENG block (just 1 mL saline). Group II (PENG group):Received real PENG block (20 mL of bupivacaine 0.25% +0.2 mg/mL dexamethasone). Results: In the PENG group, pain scoring was significantly lowered, considerably longer intervals among first pain and the need for analgesia, the total dosage of morphine used up in the first twentyfour hrs was significantly decreased, patients were very satisfied, there was no motor blockage nor quadriceps muscle affection compared with control group. Inconsequential differences existed between both group in time to first sit and time to do active exercise but there was a drastic drop in time to stand and walk in PENG group in contrast to the placebo group, Following the operation, cases in the PENG group experienced a substantially reduced rate of nausea and vomiting compared to control group. But As far as bradycardia, hypotension, and respiratory depression go, there were no discernible changes among the two groups. Conclusion:The preoperative ultrasound guided PENG block is an efficient tool for postoperative analgesia in cases undergoing total hip arthroplasty without significant effect on motor block or the incidence of complications.

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The Pericapsular Nerve Group (PENG) block combined with Local Infiltration Analgesia (LIA) compared to placebo and LIA in hip arthroplasty surgery: a multi-center double-blinded randomized-controlled trial

Cited by 32 publications

References 31 publications

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

The efficacy of pericapsular nerve group block for postoperative analgesia in patients undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis

The effect of preoperative ultrasound-guided peri-capsular nerve group block (PENG) on the postoperative analgesia after total hip arthroplasty: A randomized controlled study

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