What do we know about the PENG block for hip surgery? A narrative review
Abstract
Postoperative pain management in hip surgery is classified as severe and its inadequate control leads to complications that increase patient morbidity and mortality. The PENG block is advocated as a safe, opioid-sparing analgesic technique, which provides an adequate level of analgesia. The purpose of this study is to analyze and reflect about the efficacy, safety and therapeutic appropriateness of the PENG block in hip surgery. To this end, a narrative review is conducted using various databases such as PubMed and the Cochrane library. In all of the studies analyzed, an adequate postoperative pain control was achieved using the PENG block, with reduction in pain assessment scales and opioid consumption in the first postoperative hours. Improved results were also seen as compared with other regional blocks. There were few adverse effects and none of them was classified as severe. The PENG block contributes with numerous advantages and few adverse effects for hip surgery. Further studies are needed on this block, whether alone or in combination with other regional techniques, so as to include it in analgesia protocols, developing a standardized approach and study the outcomes in more controlled settings.
References
Zhao J, Davis SP. An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty. Int J Nurs Stud. 2019;98:94-106. doi: https://doi.org/10.1016/j.ijnurstu.2019.06.010
Gaffney CJ, Pelt CE, Gililland JM, Peters CL. Perioperative pain management in hip and knee arthroplasty. Orthop Clin North Am. 2017;48(4):407-19. doi: https://doi.org/10.1016/j.ocl.2017.05.001
Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop. 2020;91(1):3-19. doi: https://doi.org/10.1080/17453674.2019.1683790
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):1-7. doi: https://doi.org/10.1097/AAP.0000000000000701
Girón-Arango L, Peng PWH, Med FP, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43(8):1-5. doi: https://doi.org/10.1097/AAP.0000000000000847
Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Reg Anesth Pain Med. 2019;44:257. doi: https://doi.org/10.1136/rapm-2018-100278
Højer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Posoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015;156(1):8-30. doi: https://doi.org/10.1016/j.pain.0000000000000003
Luftig J, Dreyfuss A, Mantuani D, Howell K, White A, Nagdev A. A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block. Am J merg Med. 2020;38(12):2761.e5-2761.e9. doi: https://doi.org/10.1016/j.ajem.2020.05.085
Strumia A, Piliego C, Quattro E De, Pascarella G, Costa F, Buono R Del, et al. Impact of the pericapsular nerve group ( PENG ) block on posoperative analgesia and functional recovery following total hip arthroplasty : a randomised , observer-masked, controlled trial. Anaesthesia. 2021;1-7. doi: https://doi.org/10.1111/anae.15536
Singh S, Singh S, Ahmed W. Continuous pericapsular nerve group block for hip surgery: A case series. 2020;14(11):12-5. doi: https://doi.org/10.1213/XAA.0000000000001320
Black ND, Chin KJ. Pericapsular nerve group (PENG) block. Comments and practical considerations. J Clin Anesth [Internet]. 2019;56:143-4. doi: https://doi.org/10.1016/j.jclinane.2019.02.010
Molinelli M, Romero JEO, Uranga S, Bartolini J, Caputo N, Ariel L, et al. Analgesic effect of the PENG lock (pericapsular nervous group) in patients with hip fracture. Rev Chil Anest. 2020;49:134-8. doi: https://doi.org/10.25237/revchilanestv49n01.11
Wang Y, Wen H, Wang M, Lu M. The efficiency of ultrasound-guided pericapsular nerve group block for pain management after hip surgery: a meta-analysis. Pain Ther. 2023;12(1):81-92. doi: https://doi.org/10.1007/s40122-022-00463-0
Huda AU, Ghafoor H. The use of pericapsular nerve group (PENG) block in hip surgeries is associated with a reduction in opioid consumption, less motor block, and better patient satisfaction: a meta-analysis. Cureus. 2022;14(9):28872. doi: https://doi.org/10.7759/cureus.28872
Farag A, Hendi NI, Diab RA. Does pericapsular nerve group block have limited analgesia at the initial post-operative period? Systematic review and meta-analysis. J Anesth. 2023;37(1):138-53. doi: https://doi.org/10.1007/s00540-022-03129-5
Morrison C, Brown B, Lin DY, Jaarsma R, Kroon H. Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review. Reg Anesth Pain Med. 2021;46(2):169-75. doi: https://doi.org/10.1136/rapm-2020-101826
Hua H, Xu Y, Jiang M, Dai X. Evaluation of pericapsular nerve group (PENG) block for analgesic effect in elderly patients with femoral neck fracture undergoing hip arthroplasty. J Healthc Eng. 2022;9:716-45. doi: https://doi.org/10.1155/2022/7452716
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: https://doi.org/10.1136/rapm-2020-102315
Zheng L, Jo Y, Hwang J, Rhim H, Park E, Oh C, et al. Comparison of the analgesic efficacy of periarticular infiltration and pericapsular nerve group block for total hip arthroplasty: a randomized, non-inferiority study. Ann Palliat Med. 2022;11(4):1222-30. doi: https://doi.org/10.21037/apm-21-2785
Allard C, Pardo E, de la Jonquière C, Wyniecki A, Soulier A, Faddoul A, et al. Comparison between femoral block and PENG block in femoral neck fractures: A cohort study. PLoS One. 2021;16(6):e0252716. doi: https://doi.org/10.1371/journal.pone.0252716
Remily EA, Hochstein SR, Wilkie WA, Mohamed NS, Thompson JV, Kluk MW, et al. The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? Hip Int. 2022;32(3):318-25. doi: https://doi.org/10.1177/1120700020978211
Mysore K, Sancheti SA, Howells SR, Ballah EE, Sutton JL, Uppal V. Posoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study. Can J Anaesth. 2020;67(11):1673-4. doi: https://doi.org/10.1007/s12630-020-01751-z
Da Costa AO, Izolani GV, Monteiro de Souza IF, Martins Santiago BV. Continuous pericapsular nerve group (PENG) block through an elastomeric infusion system, associated with the lateral cutaneous nerve block of the thigh for total hip arthroplasty. BMJ Case Rep. 2022;29;15(3):e246833. doi: https://doi.org/10.1136/bcr-2021-246833
Kukreja P, Avila A, Northern T, Dangle J, Kolli S, Kalagara H. A retrospective case series of pericapsular nerve group (PENG) block for primary versus revision total hip arthroplasty analgesia. Cureus. 2020;19;12(5):e8200. doi: https://doi.org/10.7759/cureus.8200
Tovar-Gutiérrez A, Camelo-Rincón JE, Vásquez-Gómez ÓI, Cadavid-Puentes AM. Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series. Colombian Journal of Anesthesiology. 2021;49:e962. doi: https://doi.org/10.5554/22562087.e962
Carvajal Roa JJ, Victoria Cuéllar DF, Arango Sakamoto A, Cruz Suárez GA, Billefals Vallejo ES, Moreno M, et al. Experience in the perioperative management of patients with hip fracture in southwestern Colombia. Retrospective cohort study. Colombian Journal of Anesthesiology. 2023;51:e1080. doi: https://doi.org/10.5554/22562087.e1080
Downloads
Copyright (c) 2023 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
