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

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

Abstract

Background: The PEricapsular Nerve Group (PENG) block is a novel regional analgesia technique that provides improved analgesia in patients undergoing hip surgery while preserving motor function. In this study the PENG block was investigated for analgesia in elective total hip arthroplasty (THA).

Methods: In this multi-centre double-blinded randomized-controlled trial, in addition to spinal anesthesia and local infiltration analgesia (LIA), THA patients received either a PENG block or a sham block. The primary outcome was pain score (numeric rating scale 0-10) 3 h postoperatively (Day 0). Secondary outcomes were postoperative quadriceps muscle strength, postoperative Day 1 pain scores, opiate use, complications, length of hospital stay, and patient-reported outcome measures.

Results: Sixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperative Day 0, the PENG group experienced less pain compared to the sham group (PENG: 14 (47%) patients no pain, 14 (47%) mild pain, 2 (6%) moderate/severe pain versus sham: 6 (20%) no pain, 14 (47%) mild pain, 10 (33%) moderate/severe pain; p = 0.03). There was no difference in quadriceps muscle strength between groups on Day 0 (PENG: 23 (77%) intact versus sham: 24 (80%) intact; p = 0.24) and there were no differences in other secondary outcomes.

Conclusions: Patients receiving a PENG block for analgesia in elective THA experience less postoperative pain on Day 0 with preservation of quadriceps muscle strength. Despite these short-term benefits, no quality of recovery or longer lasting postoperative effects were detected.

Keywords: Analgesia; Anesthesia; Hip arthroplasty; PENG; PROMs; Pain; Patient reported outcome measures; Pericapsular nerve group block; Regional analgesia; Sham.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram

References

    1. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86(5):963–74. doi: 10.2106/00004623-200405000-00012.
    1. Osteoarthritis
    1. Gaffney CJ, Pelt CE, Gililland JM, Peters CL. Perioperative Pain Management in Hip and Knee Arthroplasty. Orthop Clin North Am. 2017;48(4):407–419. doi: 10.1016/j.ocl.2017.05.001.
    1. Lindenhovius AL, Helmerhorst GT, Schnellen AC, Vrahas M, Ring D, Kloen P. Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and The Netherlands. J Trauma. 2009;67(1):160–164.
    1. Shah R, Kuo YF, Westra J, Lin YL, Raji MA. Opioid Use and Pain Control After Total Hip and Knee Arthroplasty in the US, 2014 to 2017. JAMA Netw Open. 2020;3(7):e2011972. doi: 10.1001/jamanetworkopen.2020.11972.
    1. Ibrahim MS, Khan MA, Nizam I, Haddad FS. Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Med. 2013;11:37. doi: 10.1186/1741-7015-11-37.
    1. De Luca ML, Ciccarello M, Martorana M, Infantino D, Letizia Mauro G, Bonarelli S, et al. Pain monitoring and management in a rehabilitation setting after total joint replacement. Medicine (Baltimore) 2018;97(40):e12484. doi: 10.1097/MD.0000000000012484.
    1. Pepper AM, Mercuri JJ, Behery OA, Vigdorchik JM. Total Hip and Knee Arthroplasty Perioperative Pain Management: What Should Be in the Cocktail. JBJS Rev. 2018;6(12):e5. doi: 10.2106/JBJS.RVW.18.00023.
    1. Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013;118(2):409–415. doi: 10.1097/ALN.0b013e318279fa0b.
    1. Lin DY, Brown B, Morrison C, Kroon HM, Jaarsma RL. 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. J Int Med Res. 2022;50(3):3000605221085073.
    1. Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018;43(8):859–863.
    1. Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Reg Anesth Pain Med. 2019:rapm-2018-100278. 10.1136/rapm-2018-100278. Epub ahead of print.
    1. Lin DY, Morrison C, Brown B, Saies AA, Pawar R, Vermeulen M, et al. 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. Reg Anesth Pain Med. 2021;46(5):398–403. doi: 10.1136/rapm-2020-102315.
    1. Lin DY, Morrison C, Brown B, Saies A, Pawar R, Vermeulen M, et al. In reply to: 'towards precision regional anesthesia: is the PENG block appropriate for all hip fracture surgeries?'. Reg Anesth Pain Med. 2022;47(1):77–78. doi: 10.1136/rapm-2021-102926.
    1. Pascarella G, Costa F, Del Buono R, Pulitano R, Strumia A, Piliego C, et al. Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia. 2021;76:1492–1498. doi: 10.1111/anae.15536.
    1. Andersen LO, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth. 2014;113(3):360–374. doi: 10.1093/bja/aeu155.
    1. Calvert M, Blazeby J, Altman DG, Revicki DA, Moher D, Brundage MD, et al. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013;309(8):814–822. doi: 10.1001/jama.2013.879.
    1. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.
    1. Uppal V, Retter S, Shanthanna H, Prabhakar C, McKeen DM. Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery. Anesth Analg. 2017;125(5):1627–1637. doi: 10.1213/ANE.0000000000002254.
    1. Hampton SN, Nakonezny PA, Richard HM, Wells JE. Pain catastrophizing, anxiety, and depression in hip pathology. Bone Joint J. 2019;101-B(7):800–7. doi: 10.1302/0301-620X.101B7.BJJ-2018-1309.R1.
    1. Saporito S, Brodie MA, Delbaere K, Hoogland J, Nijboer H, Rispens SM, et al. Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery. Physiol Meas. 2019;40(3):035004. doi: 10.1088/1361-6579/ab0d3e.
    1. Schalet BD, Pilkonis PA, Yu L, Dodds N, Johnston KL, Yount S, et al. Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples. J Clin Epidemiol. 2016;73:119–127. doi: 10.1016/j.jclinepi.2015.08.036.
    1. Sorel JC, Veltman ES, Honig A, Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2019;101-B(1):7–14. doi: 10.1302/0301-620X.101B1.BJJ-2018-0672.R1.
    1. Myles PS. Measuring quality of recovery in perioperative clinical trials. Curr Opin Anaesthesiol. 2018;31(4):396–401. doi: 10.1097/ACO.0000000000000612.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/.
    1. Gasanova I, Alexander JC, Estrera K, Wells J, Sunna M, Minhajuddin A, et al. Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2019;44(2):206–211. doi: 10.1136/rapm-2018-000016.
    1. Kenyon-Smith T, Nguyen E, Oberai T, Jarsma R. Early Mobilization Post-Hip Fracture Surgery. Geriatr Orthop Surg Rehabil. 2019;10:2151459319826431. doi: 10.1177/2151459319826431.
    1. Baer M, Neuhaus V, Pape HC, Ciritsis B. Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures. SICOT J. 2019;5:4. doi: 10.1051/sicotj/2019005.
    1. Kuru T, Olcar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: a retrospective analysis. Turk J Med Sci. 2020;50(1):117–125.
    1. Zheng J, Pan D, Zheng B, Ruan X. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Reg Anesth Pain Med. 2022;47(3):155–60. 10.1136/rapm-2021-103228. Epub 2021 Dec 6. Erratum in: Reg Anesth Pain Med. 2022;47(7):e4.

Source: PubMed

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