The Use of Pericapsular Nerve Group (PENG) Block in Hip Surgery

Abstract

Introduction: Pericapsular nerve group (PENG) block is a recently introduced pain control method indicated for hip fracture. Anterior capsule is the most abundantly innervated site of the joint. Therefore, unlike the common performed peripheral block, PENG block was proposed to provide a complete analgesia. Objective: This systematic review aims to evaluate the effect of PENG block in hip fracture surgery and hip arthroplasty. Methods: A comprehensive search was conducted in PubMed, ScienceDirect, and ClinicalKey databases until July 31st 2022 with the following keyword: “pericapsular nerve group block”. Results: Nine studies were included in the final qualitative synthesis. Compared to most commonly performed peripheral nerve blocks (femoral nerve block (FNB) or fascia iliac compartment block (FICB)), the PENG block seemed to offer better pain control (three studies reported better post-operative pain score (VAS) and one showed immediate pain improvement at 10, 20, and 30 minutes after block). The PENG block also increased the period of analgesic-free window and lowered the amount of opioid use. Mobility and length of stay were reported superior in PENG block. A study comparing PENG block with periarticular infiltration also reported lower cumulative opioid consumption, although it is not significant. In one study, PENG block was compared with no block and resulted in significantly better post-operative pain, lesser opioid dose, longer time to first opioid need, and better mobility. If not fewer, adverse events were comparable in PENG block than other techniques. Conclusion: Pericapsular nerve group block appears to have beneficial effects in hip surgery. This analgesic method may provide better outcomes in pain control, use of opioid, mobility, and length of hospital stay. However, future studies are expected to confirm these results.