Effects of pericapsular nerve group (PENG) block on postoperative recovery in elderly patients with hip fracture: study protocol for a randomised, parallel controlled, double-blind trial

Wei Luo, Jianhui Liang, Jieting Wu, Quehua Luo, Huiyi Wu, Yanhua Ou, Yuhui Li, WuHua Ma, Wei Luo, Jianhui Liang, Jieting Wu, Quehua Luo, Huiyi Wu, Yanhua Ou, Yuhui Li, WuHua Ma

Abstract

Introduction: Hip fracture is a common and serious emergency in the elderly, and it is associated with severe pain, significant morbidity and mortality. The use of peripheral nerve block can relieve pain effectively and reduce opioid requirements, which may accelerate patient's recovery. The pericapsular nerve group (PENG) block has been found to provide an effective blockade to the hip joint with a potential motor-sparing effect, so we hypothesised that the PENG block may be an effective tool to enhance the recovery in elderly patients after hip fracture surgery.

Methods and analysis: This study is a single-centred, randomised, parallel controlled, double-blind trial. A total of 92 elderly patients scheduled for hip fracture surgery will be divided into two groups at random to receive either ultrasound-guided femoral nerve block or ultrasound-guided PENG block. The primary outcome will be to compare the Quality of Recovery-15 scores at 24 hours postoperatively between the two groups. The secondary outcomes will include measuring and comparing the strength of the quadriceps, the visual analogue scale at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilisation and complications.

Ethics and dissemination: This study was approved by the Institutional Review Board of the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (reference K2020-110). The results of this study will be published in peer-reviewed international journals.

Trial registration number: ChiCTR2100042341.

Keywords: anaesthesia in orthopaedics; hip; pain management; rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The flow diagram for this trial. ASA, American Society of Anesthesiologists class; FN, femoral nerve; MMSE: mini-mental state examination; PCIA, patient controlled intravenous analgesia; PENG, pericapsular nerve group; QoR-15, Quality of Recovery-15; VAS, visual analogue scale.

References

    1. Fox KM, Magaziner J, Hawkes WG, et al. . Loss of bone density and lean body mass after hip fracture. Osteoporos Int 2000;11:31–5. 10.1007/s001980050003
    1. National clinical guideline centre . The management of hip fracture in adults. London:, 2017. Available:
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJM, et al. . Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934–44. 10.1097/ALN.0b013e31828866b3
    1. Morrison SR, Magaziner J, McLaughlin MA, et al. . The impact of post-operative pain on outcomes following hip fracture. Pain 2003;103:303–11. 10.1016/S0304-3959(02)00458-X
    1. Halaszynski TM. Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol 2009;22:594–9. 10.1097/ACO.0b013e32833020dc
    1. Hebl JR, Dilger JA, Byer DE, et al. . A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med 2008;33:510–7. 10.1097/00115550-200811000-00002
    1. Ellis TA, Hammoud H, Dela Merced P, et al. . Multimodal Clinical Pathway With Adductor Canal Block Decreases Hospital Length of Stay, Improves Pain Control, and Reduces Opioid Consumption in Total Knee Arthroplasty Patients: A Retrospective Review. J Arthroplasty 2018;33:2440–8. 10.1016/j.arth.2018.03.053
    1. Fabi DW. Multimodal analgesia in the hip fracture patient. J Orthop Trauma 2016;30 Suppl 1:S6–11. 10.1097/BOT.0000000000000561
    1. Unneby A, Svensson O, Gustafson Y, et al. . Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial. Injury 2017;48:1542–9. 10.1016/j.injury.2017.04.043
    1. Haines L, Dickman E, Ayvazyan S, et al. . Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J Emerg Med 2012;43:692–7. 10.1016/j.jemermed.2012.01.050
    1. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med 2013;20:584–91. 10.1111/acem.12154
    1. Girón-Arango L, Peng PWH, Chin KJ, et al. . Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med 2018;43:859–63. 10.1097/AAP.0000000000000847
    1. Sandri M, Blasi A, De Blasi RA. PENG block and LIA as a possible anesthesia technique for total hip arthroplasty. J Anesth 2020;34:472–5. 10.1007/s00540-020-02768-w
    1. Fusco P, Di Carlo S, Paladini G, et al. . Could the combination of PENG block and LIA be a useful analgesic strategy in the treatment of postoperative pain for hip replacement surgery? Reg Anesth Pain Med 2019;44:531. 10.1136/rapm-2018-100277
    1. Casas Reza P, Diéguez García P, Gestal Vázquez M, et al. . Pericapsular nerve group block for hip surgery. Minerva Anestesiol 2020;86:463–5. 10.23736/S0375-9393.20.14166-X
    1. Lin D-Y, Morrison C, Brown B, 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;46:398–403. 10.1136/rapm-2020-102315
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, et al. . Spirit 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013;346:e7586. 10.1136/bmj.e7586
    1. Girard TD, Thompson JL, Pandharipande PP, et al. . Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med 2018;6:213–22. 10.1016/S2213-2600(18)30062-6
    1. Mistry T, Sonawane KB, Bapurao SK. Gray zone of pericapsular nerve group (PENG) block. J Clin Anesth 2019;58:123–4. 10.1016/j.jclinane.2019.07.006
    1. Black ND, Chin KJ. Pericapsular nerve group (PENG) block: comments and practical considerations. J Clin Anesth 2019;56:143–4. 10.1016/j.jclinane.2019.02.010
    1. Marhofer P, Schrögendorfer K, Koinig H, et al. . Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997;85:854–7. 10.1213/00000539-199710000-00026
    1. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology 2013;118:1332–40. 10.1097/ALN.0b013e318289b84b
    1. Bu X-S, Zhang J, Zuo Y-X. Validation of the Chinese version of the quality of Recovery-15 score and its comparison with the post-operative quality recovery scale. Patient 2016;9:251–9. 10.1007/s40271-015-0148-6
    1. Edwards MD, Bethea JP, Hunnicutt JL, et al. . Effect of adductor canal block versus femoral nerve block on quadriceps strength, function, and postoperative pain after anterior cruciate ligament reconstruction: a systematic review of level 1 studies. Am J Sports Med 2020;48:2305–13. 10.1177/0363546519883589
    1. Myles PS, Myles DB, Galagher W, et al. . Minimal clinically important difference for three quality of recovery scales. Anesthesiology 2016;125:39–45. 10.1097/ALN.0000000000001158
    1. Gomes T, Tadrous M, Mamdani MM, et al. . The burden of opioid-related mortality in the United States. JAMA Netw Open 2018;1:e180217. 10.1001/jamanetworkopen.2018.0217
    1. Wetzel M, Hockenberry J, Raval MV. Interventions for postsurgical opioid prescribing: a systematic review. JAMA Surg 2018;153:948–54. 10.1001/jamasurg.2018.2730
    1. Birke H, Ekholm O, Sjøgren P, et al. . Long‐term opioid therapy in Denmark: a disappointing journey. Eur J Pain 2017;21:1516–27. 10.1002/ejp.1053
    1. Simoni AH, Nikolajsen L, Olesen AE, et al. . Opioid use after hip fracture surgery: a Danish nationwide cohort study from 2005 to 2015. Eur J Pain 2019;23:1309–17. 10.1002/ejp.1392
    1. Scurrah A, Shiner CT, Stevens JA, et al. . Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review. Anaesthesia 2018;73:769–83. 10.1111/anae.14178
    1. Reid N, Stella J, Ryan M, et al. . Use of ultrasound to facilitate accurate femoral nerve block in the emergency department. Emerg Med Australas 2009;21:124–30. 10.1111/j.1742-6723.2009.01163.x
    1. Short AJ, Barnett JJG, Gofeld M, et al. . Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Reg Anesth Pain Med 2018;43:186–92. 10.1097/AAP.0000000000000701
    1. Birnbaum K, Prescher A, Hessler S, et al. . The sensory innervation of the hip joint--an anatomical study. Surg Radiol Anat 1997;19:371–5. 10.1007/BF01628504
    1. Gerhardt M, Johnson K, Atkinson R, et al. . Characterisation and classification of the neural anatomy in the human hip joint. Hip Int 2012;22:75–81. 10.5301/HIP.2012.9042
    1. Ali AM, Tahoun HM, Ahmed AA. Comparative study between the analgesic efficacies of nerve stimulator-guided 3-in-1 block, ultrasonographic-guided 3-in-1 block and posterior approach lumbar plexus block following total hip arthroplasty. Egyptian J Anaesth 2003;19:39–43
    1. Dolan J, Williams A, Murney E, et al. . Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med 2008;33:526–31. 10.1016/j.rapm.2008.03.008
    1. Swenson JD, Davis JJ, Stream JO, et al. . Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. J Clin Anesth 2015;27:652–7. 10.1016/j.jclinane.2015.07.001
    1. Kuang M-J, Ma J-X, Fu L, et al. . Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A grade analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty 2017;32:3238–48. 10.1016/j.arth.2017.05.015
    1. Yu HC, Moser JJ, Chu AY, et al. . Inadvertent quadriceps weakness following the pericapsular nerve group (PENG) block. Reg Anesth Pain Med 2019;44:611–3. 10.1136/rapm-2018-100354
    1. Ince I, Kilicaslan A, Kutlu E, et al. . Combined pericapsular nerve block (PENG) and lumbar erector spinae plane (ESP) block for congenital hip dislocation surgery. J Clin Anesth 2020;61:109671. 10.1016/j.jclinane.2019.109671
    1. Aliste J, Layera S, Bravo D, et al. . Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total hip arthroplasty. Reg Anesth Pain Med 2021;46:874–8. 10.1136/rapm-2021-102997

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