Efficacy of iliopsoas plane block for patients undergoing hip arthroscopy: a prospective, triple-blind, randomized, placebo-controlled trial

Pericapsular nerve group (PENG) block: what have we learned in the last 5 years?

This educational article discusses the current understanding of the pericaspular nerve group block (PENG) of the hip regarding its mechanism of action and spread patterns, as well as plausible explanations for postblock quadriceps weakness. Finally, we will discuss the recent evidence of PENG block as an analgesic block in hip fractures and in different hip surgeries.

Iliopsoas plane block versus femoral nerve block for postoperative quality of recovery following hip arthroplasty: a randomized controlled trial

The iliopsoas plane block (IPB) is a novel analgesic technique that has been demonstrated to be effective for hip fracture and hip replacement surgery. This study aimed to assess the effect of IPB on postoperative quality of recovery following elective hip arthroplasty compared with femoral nerve block (FNB). One hundred patients underwent elective hip arthroplasty were randomly assigned to the IPB or FNB groups. The primary outcome was the quality of recovery 24 h after surgery. Secondary outcomes included the quality of recovery at 48 and 72 h after surgery, pain scores, quadriceps strength, first time out of bed, total opioid consumption, patient satisfaction, and complications. Compared with participants in the FNB group, Quality of recovery-15 score at 24-h was significantly higher in the IPB group (127 [123-130] vs. 117.5 [113.7-120.2]), with a median difference of 9 (95% CI, 7-11; P < 0.001). Moreover, the QoR-15 score of the IPB group was higher than that of the FNB group at 48 and 72 h after surgery (P < 0.001). However, there were no clinically significant differences between the two groups. Quadriceps strength was superior in the IPB group than that in the FNB group (P < 0.001). The first time out of bed was shorter in the IPB group than that in the FNB group (P < 0.001). This study found that IPB enhanced the quality of recovery in the first 24 h following hip arthroplasty compared with FNB.Trial registration Chinese Clinical Trial Registry ChiCTR2200055289.

FRONT block: a cadaveric study of a dual-plane injection block targeting femoral rami and obturator nerve trunk for anterior hip joint analgesia

BACKGROUND

The quest for a single nerve block to anesthetize all anterior hip articular nerve branches has long been a challenge for anesthetists, particularly in targeting the obturator nerve (ON). The FRONT block (Femoral Rami Obturator Nerve Trunk) is a newly developed dual-injection technique providing comprehensive anesthetic coverage of the anterior hip joint by targeting both the sensory femoral rami and the ON trunk.

METHODS

15 intact cadaveric sides from eight embalmed cadavers were dissected after FRONT block administration with one injection and two dye deposits in the iliopsoas plane and in the subpectineal compartment under dynamic ultrasonography. The primary outcome was dye spread to the sensory hip articular branches of the femoral nerve (FN) and the ON trunk evaluated during the gross anatomical dissection. Secondary outcomes included identifying landmarks for accurate injection of dye and measuring the distance from the needle trajectory to the femoral and the lateral femoral cutaneous nerves (LFCN).

RESULTS

In 86.7% of cadaver sides, the FRONT block successfully covered both the sensory femoral rami and the ON trunk. The injection was performed 6.7 cm (SD 1.6) distal to the anterior superior iliac spine with a medial deviation of 1.8 cm (SD 2.1). The average distance from the needle trajectory to the FN was 0.8 cm (SD 0.4) and 3.7 (SD 2.1) cm to the LFCN.

CONCLUSION

The FRONT block offers reliable coverage of the anterior hip joint and capsule. Proficiency in ultrasound-guided regional anesthesia is important during clinical applications.

Subpectineal obturator nerve block reduces opioid consumption after hip arthroscopy: a triple-blind, randomized, placebo-controlled trial

BACKGROUND

Hip arthroscopy causes severe pain during the first few hours in the postoperative care unit. This is probably due to the intraoperative stretching of the hip joint capsule. Pain relief requires high doses of opioids which may prolong recovery and may cause opioid-related adverse events.The majority of hip joint capsule nociceptors are located anteriorly. The obturator nerve innervates the anteromedial part of the hip joint capsule. We hypothesized that a subpectineal obturator nerve block using 15 ml bupivacaine 5 mg/mL with added epinephrine 5 μg/mL would reduce the opioid consumption after hip arthroscopy.

METHODS

40 ambulatory hip arthroscopy patients were enrolled in this randomized, triple-blind controlled trial. All patients were allocated to a preoperative active or placebo subpectineal obturator nerve block. The primary outcome was opioid consumption for the first 3 hours in the postanesthesia care unit. Secondary outcomes were pain, nausea, and hip adductor strength.

RESULTS

34 patients were analyzed for the primary outcome. The mean intravenous morphine equivalent consumption in the subpectineal obturator nerve block group was 11.9 mg vs 19.7 mg in the placebo group (p<0.001). The hip adductor strength was significantly reduced in the active group. No other intergroup differences were observed regarding the secondary outcomes.

CONCLUSION

We found a significant reduction in the opioid consumption for patients receiving an active subpectineal obturator nerve block. The postoperative intravenous morphine equivalent reduction the first painful 3 hours was reduced by 40% for patients receiving a subpectineal obturator nerve block in this randomized, triple-blind trial.

TRIAL REGISTRATION NUMBER

EudraCT database 2021-006575-42.