Comparison of analgesic effects of pericapsular nerve group block and fascia iliaca compartment block during hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials

PENG Block: A superior alternative for pain management in intracapsular hip fractures

Background and Objectives

Previous studies have demonstrated the effectiveness of regional analgesic techniques for pain management after hip surgery; however, no clear superiority between these techniques has been established. A key limitation of these studies is the lack of differentiation between fracture subtypes. This prospective, comparative cohort study aims to evaluate the effectiveness of two regional techniques-pericapsular nerve group block (PENG) and suprainguinal iliac fascia block (FICB)-in providing perisurgical analgesia for intracapsular femoral fractures.

Materials and Methods

Sixty-four patients undergoing elective surgery for intracapsular femoral fractures were randomly assigned to receive either a PENG block or an FICB block, each with 15 mL of 0.2% ropivacaine. Intradural anesthesia and conventional intravenous analgesia were administered during surgery. The primary outcome was pain scores in the recovery room and 24 hours post-surgery. Secondary outcomes included the need for intravenous opioid rescue medication during the first 24 hours.

Results

The PENG group demonstrated significantly lower postoperative pain scores compared to the FICB group both immediately after surgery (P = 0.006) and at 24 hours (P < 0.001). Additionally, fewer patients in the PENG group required weak opioids in the first 24 hours following surgery (P = 0.001).

Conclusions

The PENG block provides superior postoperative analgesia for intracapsular femoral fractures compared to the FICB block following hip surgery, with reduced opioid consumption observed in the PENG group.

Clinical Trial Registration

NCT05377541.

Pericapsular nerve group block reduces opioid use and pain after hip surgery: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial.

METHODS

We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system.

RESULTS

We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system.

CONCLUSIONS

The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia.

Effects of ultrasound‑guided pericapsular nerve group block in combination with laryngeal mask airway on anesthesia, postoperative analgesia, and recovery of elderly patients with femoral neck fracture undergoing closed reduction and internal fixation

INTRODUCTION

Femoral neck fracture (FNF) frequently occurs in the elderly. FNF is usually treated surgically, but patients often have comorbidities, which make the surgery complicated and increase the intraoperative risk.

AIM

We aimed to assess the effects of ultrasound‑guided pericapsular nerve group block (PENGB) coupled with laryngeal mask airway (LMA) general anesthesia on anesthetic efficacy in elderly patients suffering from FNF undergoing closed reduction and internal fixation (CRIF), as well as their postopera‑ tive analgesia and rapid recovery.

MATERIALS AND METHODS

Control group (n = 47) and study group (n = 57) were established for FNF patients hospitalized between October 2022 and August 2023, based on different anesthesia modes. Ultrasound‑guided fascia iliaca compartment block (FICB) and LMA general anesthesia were offered to the control group, while the study group underwent ultrasound‑guided PENGB and LMA general anesthesia.

RESULTS

In comparison with the study group, heart rate (HR) and mean arterial pressure rose significantly in the control group at the time of skin incision, 20 minutes intraoperatively, and at the end of the surgery, and HR also increased when the patients entered a postanesthetic care unit (P <0.05). The study group, in comparison with the control group, exhibited reduced serum neuropeptide Y and substance P levels at 12 and 24 hours postoperatively, and lowered Visual Analogue Scale scores at various time points following the operation (P <0.05). In comparison with the control group, the study group had shorter postoperative eye‑opening, extubation, and ambulation times (P <0.05).

CONCLUSIONS

Ultrasound‑guided PENGB with LMA general anesthesia are effective in elderly patients with FNF undergoing CRIF, and can stabilize the intraoperative hemodynamic state.

Efficacy of Supplemental Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block in Patients Receiving Local Infiltration Analgesia after Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Background and Objectives: Local infiltration analgesia (LIA) represents a potential approach to reducing pain in patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block also provides adequate analgesia for fractures and THA. As most hip surgeries use a lateral incision, affecting the cutaneous supply by branches of the lateral femoral cutaneous nerve (LFCN), the LFCN block can contribute to postoperative analgesia. However, no studies have investigated the effectiveness of supplemental PENG block combined with LFCN block in patients undergoing LIA after hip fracture surgery. Our study aimed to assess the effectiveness of PENG combined with LFCN block following hip fracture surgery in patients who underwent LIA. Materials and Methods: Forty-six patients were randomly assigned to LIA or PENG + LFCN + LIA groups. The primary outcome was the pain score at rest and during movement at 2, 6, 12, 24, and 48 h postoperatively. The total opioid dose for postoperative analgesia was also measured at the same time points. Secondary outcomes included postoperative cognitive function assessment. Results: The median pain scores at rest and during movement were lower in the PENG + LFCN + LIA group throughout the study periods compared to the LIA group, except at 2 h (at rest) and 48 h (during movement) after surgery. The total fentanyl dose was lower in the PENG + LFCN + LIA group at all time points after surgery when compared to the LIA group. Postoperative delirium incidence and the median abbreviated mental test scores were not significantly different between the two groups. Conclusions: The combination of PENG and LFCN blocks may contribute to enhanced recovery for patients undergoing LIA after hip fracture surgery. However, further well-controlled research is necessary to determine the effectiveness of supplemental PENG combined with LFCN block in addressing cognitive deficits in these patients.