Pericapsular Nerve Group (PENG) Block in Combination With the Quadratus Lumborum Block Analgesia for Revision Total Hip Arthroplasty: A Retrospective Case Series

Promil Kukreja, Braden Schuster, Theresa Northern, Sandra Sipe, Sameer Naranje, Hari Kalagara, Promil Kukreja, Braden Schuster, Theresa Northern, Sandra Sipe, Sameer Naranje, Hari Kalagara

Abstract

Orthopedic procedures involving the hip have remained challenging for regional anesthesia given the complex innervation, painful nature contributing to difficulty positioning, and a desire to maintain mobility to hasten postoperative recovery. The revision total hip arthroplasty (THA) poses a greater challenge for an effective regional analgesia due to complex surgical approach, scarring from previous surgery and limited patient mobility. The quadratus lumborum (QL) block has demonstrated to provide effective analgesia for primary hip surgery in recent studies. The pericapsular nerve group (PENG) block has also shown to provide analgesia in patients with hip fractures. There is no standard of care regional anesthesia technique for hip surgeries, and the regional practice varies widely among anesthesia providers. This retrospective case series studied the effect of combining the QL with PENG block on the revision THA analgesia.

Keywords: analgesia; nerve block; pericapsular nerve group (peng); quadratus lumborum; regional anesthesia; total hip arthroplasty.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Kukreja et al.

Figures

Figure 1. PENG BLOCK: Three black arrows…
Figure 1. PENG BLOCK: Three black arrows indicate needle traversing from lateral to medial passing the anterior inferior iliac spine (AIIS) and depositing local anesthetic (LA) along iliopubic eminence (IPE) just lateral to femoral artery (FA).
Figure 2. Quadratus lumborum (QL) block anatomy:…
Figure 2. Quadratus lumborum (QL) block anatomy: In anterior QL block, local anesthetic is injected along anterior border of QL muscle in fascial plane between QL and psoas major muscles.
Figure 3. Average OMEs (mg) for PENG…
Figure 3. Average OMEs (mg) for PENG plus QL (blue) versus QL only (orange) groups for Revision THA.
OME: Oral morphine equivalent; PENG: Pericapsular nerve group; QL: Quadratus lumborum; THA: Total hip arthroplasty.
Figure 4. Total OMEs for QL only…
Figure 4. Total OMEs for QL only (orange) versus PENG plus QL (blue) groups in first 12 and first 24 hours in post-operative period.
OME: Oral morphine equivalent; QL: Quadratus lumborum; PENG: Pericapsular nerve group.

References

    1. A retrospective case series of pericapsular nerve group (PENG) block for primary versus revision total hip arthroplasty analgesia. Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. Cureus. 2020;12:0.
    1. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Nikolajsen I, Brandsborg B, Lucht U, Jensen TS, Kehlet H. Acta Anesthesiol Scand. 2006;50:495–500.
    1. Pericapsular nerve group (PENG) block for hip fracture. Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Reg Anesth Pain Med. 2018;43:859–863.
    1. Continuous quadratus lumborum block analgesia for total hip arthroplasty revision. Johnston DF, Sondekoppam RV. J Clin Anesth. 2016;35:235–237.
    1. Postoperative pain treatment after total hip arthroplasty: a systematic review. Hojer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl J. PAIN. 2015;156:8–30.
    1. Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. Molloy IB, Martin BI, Moschetti WE, Jevsevar DS. J Bone Joint Surg Am. 2017;99:402–407.
    1. The sensory innervation of the hip joint - an anatomical study. Birnbaum K, Prescher A, Heßler S, Heller KD. Surg Radiol Anat. 1997;19:371–375.
    1. Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. Ueshima H, Otake H. J Clin Anesth. 2018;51:60–61.
    1. Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Kukreja P, Macbeth L, Sturdivant A, Morgan C, Ghanem E, Kalagara H, Chan VWS. Reg Anesth Pain Med. 2019;44:1075–1079.
    1. Quadratus lumborum block: a technical review. Gupta A, Sondekoppam R, Kalagara H. Curr Anesthesiol Rep. 2019;9:257–262.
    1. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy. Wikner M. Anaesthesia. 2017;72:230–232.
    1. Incidence of lower-extremity muscle weakness after quadratus lumborum block. Ueshima H, Otake H. J Clin Anesth. 2018;44:104.
    1. Update on selective regional analgesia for hip surgery patients. Bugada D, Bellini V, Lorini L, Mariano ER. Anesthesiology Clin. 2018;36:403–415.
    1. The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series. Elsharkawy H, El-Boghdadly K, Barnes TJ, et al. Can J Anaesth. 2019;66:894–906.
    1. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Ilfeld BM, Duke KB, Donahue MC. Anesth Analg. 2010;111:1552–1554.
    1. Continuous lumbar plexus block for postoperative pain control after total hip arthroplasty: a randomized controlled trial. Marino J, Russo J, Kenny M, Herenstein R, Livote E, Chelly JE. J Bone Joint Surg Am. 2009;91:29–37.
    1. The clinical case report: a review of its merits and limitations. Nissen T, Wynn R. BMC Res Notes. 2014;7:264.
    1. Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Reg Anesth Pain Med. 2018;43:186–192.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever