Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis

Ahmed Farag, Nada Ibrahim Hendi, Rehab Adel Diab, Ahmed Farag, Nada Ibrahim Hendi, Rehab Adel Diab

Abstract

Perioperative pain management related to hip surgical procedures is challenging. Pericapsular nerve group (PENG) block is a novel technique that is assumed to provide better analgesia in addition to its post-operative motor-sparing effect. In this review, we aim to assess the safety and efficacy of PENG block on pain management in patients undergoing hip surgeries. Fifteen clinical trials with a total of 837 patients were included. Pain scores favored PENG group when compared to FICB group (fascia iliaca compartment block) or analgesics-only group, but the difference could only be detected in the early post-operative period. Afterward, it seems to lose its superiority, and no difference could be detected. In addition, cumulative opioid consumption favored PENG group at 24 h but not at 48 h. Regarding patients' satisfaction, our analysis showed results favoring PENG group, but there was no difference in time to first opioid or length of hospital stay. The incidence of vomiting was lower in PENG, but there was no difference in the incidence of nausea, pruritis, and dizziness. PENG provides better analgesia and lower opioid consumption in the initial post-operative period. Current evidence is not enough, and further high-quality randomized controlled trials with larger sample sizes are required.

Keywords: Hip regional anaesthesia; Meta-analysis; PENG block; Pericapsular nerve group block; Systematic review.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
(PRISMA) flow chart representing the search and selection process
Fig. 2
Fig. 2
Risk of bias graph for included studies
Fig. 3
Fig. 3
Risk of bias summary according to the Cochrane risk of bias assessment tool; risk of bias domains include mainly (selection bias, performance bias, detection bias, attrition bias, and reporting bias)
Fig. 4
Fig. 4
Funnel plot of the primary outcome
Fig. 5
Fig. 5
Forest plots of standardized mean difference of dynamic pain scores measured around 30 min postoperatively comparing between PENG block and other controls. The red diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The black diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs
Fig. 6
Fig. 6
Forest plots of standardized mean difference of dynamic pain scores measured at different time points postoperatively comparing between PENG block and FICB. The red diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The black diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs
Fig. 7
Fig. 7
Forest plots of standardized mean difference of dynamic pain scores measured at different time points postoperatively comparing between PENG block and analgesics-only. The red diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The black diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs
Fig. 8
Fig. 8
Forest plots of standardized mean difference of post-operative cumulative opioid consumption at 24 h. The red diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The black diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs

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