Analgesic effect of iliopsoas plane block for hip fracture

Chun-Guang Wang, Yang Yang, Ming-Yu Yang, Xiu-Li Wang, Yan-Ling Ding, Chun-Guang Wang, Yang Yang, Ming-Yu Yang, Xiu-Li Wang, Yan-Ling Ding

Abstract

Background: Hip fracture and surgery are associated with moderate to severe pain, which hampers early mobilization and extends the hospital stay. Femoral nerve block and fascia iliaca compartment block could provide effective postoperative pain relief. Unfortunately, they could weaken the strength of the quadriceps muscle and increase the risk of falls. Iliopsoas plane block (IPB) is a novel motor-sparing regional technique, which targets the sensory branches of the hip joint originating from the femoral nerve. However, the analgesic effect of IPB has not been confirmed yet.

Case presentation: In the present case series, IPB and lateral femoral cutaneous nerve block were implemented under the guidance of ultrasound for eight patients with hip fractures. The median (IQR) visual analog scale (VAS) score (0-10; 0: no pain, 10: worst pain) decreased from 1.5 (0.25-2) before IPB to 0 (0-0) 0.5h after IPB at rest. The median (IQR) VAS score decreased from 8 (7-8) before IPB to 2 (1-2) 0.5h after IPB during flexion of hip 30°. Pain score was no more than one at rest and three during flexion of the hip 30° within 48h after surgery. Furthermore, the MMT grades of quadriceps strength were no less than four after IPB.

Conclusions: Our case series firstly highlights that IPB might be an effective analgesic technique for hip fracture and surgery, while retaining motor function.

Keywords: Analgesia; Hip fracture; Hip surgery; Iliopsoas plane block; Nerve block.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Iliopsoas plane block (a) and lateral femoral cutaneous nerve block (b). Sa indicates the sartorius muscle, RF indicates the rectus femoris muscle, IP indicates the iliopsoas muscles, HoF indicates the head of the femur, white asterisk indicates the iliofemoral ligament, TFL indicates the tensor facia latae muscle, white # indicates the lateral femoral cutaneous nerve, and white arrow indicates the needle trajectory of nerve block
Fig. 2
Fig. 2
Pain score before and 0.5h after the block at rest and during flexion of the hip. The pain score at rest for cases 1 and 5 were 0 before and after the block. The pain score at rest for cases 2, 3, 4, 6, and 7 were 0 after the block. The pain score during flexion of the hip for case 1 before and after the block was 0

References

    1. Aliste J, Layera S, Bravo D, Jara Á, Muñoz G, Barrientos C, 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(10):874–878. doi: 10.1136/rapm-2021-102997.
    1. Birnbaum K, Prescher A, Hessler S, Heller KD. The sensory innervation of the hip joint--an anatomical study. Surg Radiol Anat. 1997;19(6):371–375. doi: 10.1007/BF01628504.
    1. Endersby RVW, Moser JJ, Ho ECY, Yu HC, Spencer AO. Motor blockade after iliopsoas plane (IPB) and pericapsular nerve group (PENG) blocks: a little may go a long way. Acta Anaesthesiol Scand. 2021;65(1):135–136. doi: 10.1111/aas.13707.
    1. Fournier R, Van Gessel E, Gaggero G, Boccovi S, Forster A, Gamulin Z. Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery. Can J Anaesth. 1998;45(1):34–38. doi: 10.1007/BF03011989.
    1. Girón-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. doi: 10.1097/AAP.0000000000000847.
    1. Kuchálik J, Magnuson A, Lundin A, Gupta A. Local infiltration analgesia or femoral nerve block for postoperative pain management in patients undergoing total hip arthroplasty. A randomized, double-blind study. Scand J Pain. 2017;16:223–230. doi: 10.1016/j.sjpain.2017.05.002.
    1. Li J, Dai F, Chang D, Harmon E, Ibe I, Sukumar N, et al. A practical analgesia approach to fragility hip fracture: a single-center, retrospective, cohort study on femoral nerve block. J Orthop Trauma. 2019;33(4):175–179. doi: 10.1097/BOT.0000000000001391.
    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. Nie H, Yang YX, Wang Y, Liu Y, Zhao B, Luan B. Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture. Pain Res Manag. 2015;20(4):210–212. doi: 10.1155/2015/872651.
    1. Nielsen ND, Greher M, Moriggl B, Hoermann R, Nielsen TD, Børglum J, et al. Spread of injectate around hip articular sensory branches of the femoral nerve in cadavers. Acta Anaesthesiol Scand. 2018;62(7):1001–1006. doi: 10.1111/aas.13122.
    1. Nielsen ND, Madsen MN, Østergaard HK, Bjørn S, Pedersen EM, Nielsen TD, et al. An iliopsoas plane block does not cause motor blockade-a blinded randomized volunteer trial. Acta Anaesthesiol Scand. 2020;64(3):368–377. doi: 10.1111/aas.13498.
    1. Nielsen ND, Runge C, Clemmesen L, Børglum J, Mikkelsen LR, Larsen JR, et al. An obturator nerve block does not alleviate postoperative pain after total hip arthroplasty: a randomized clinical trial. Reg Anesth Pain Med. 2019;44(4):rapm-2018-100104. doi: 10.1136/rapm-2018-100104.
    1. Pascarella G, Costa F, Del Buono R, Pulitanò R, Strumia A, Piliego C, De Quattro E, Cataldo R, Agrò FE, Carassiti M, collaborators 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(11):1492–1498. doi: 10.1111/anae.15536.
    1. Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, et al. Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(2):186–192. doi: 10.1097/AAP.0000000000000701.
    1. Simons MJ, Amin NH, Cushner FD, Scuderi GR. Characterization of the neural anatomy in the hip joint to optimize periarticular regional anesthesia in total hip arthroplasty. J Surg Orthop Adv. 2015;24(4):221–224. doi: 10.1002/sce.3730300316.
    1. Vilhelmsen F, Nersesjan M, Andersen JH, Danker JK, Broeng L, Hägi-Pedersen D, et al. Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: a randomized trial in healthy volunteers. BMC Anesthesiol. 2019;19(1):165. doi: 10.1186/s12871-019-0833-4.
    1. Yu HC, Moser JJ, Chu AY, Montgomery SH, Brown N, Endersby RVW. Inadvertent quadriceps weakness following the pericapsular nerve group (PENG) block. Reg Anesth Pain Med. 2019;44(5):611–613. doi: 10.1136/rapm-2018-100354.

Source: PubMed

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