Pericapsular Nerve Group (PENG) Block Is a Novel Technique in the Hip Surgery
-
Ebrahim Espahbodi
,
Reza Atef Yekta
,
Hossein Majedi
,
Alireza Manafi Rasi
,
Hasan Shakiba
,
Pooya Kalani
Abstract
Background: Peritrochantric fracture is common especially in elderly patients. Very often we are faced with elderly and fragile patients with several comorbidities. In these cases a careful anesthetic technique is crucial to reduce comorbidity and mortality. Currently the pericapsular nerve group (PENG) block are introduced as an analgesic technique. We used PENG block for purpose of hip surgical Anesthesia.
Methods: In this single-centre, case series, patients undergoing gama nailing for peritrochanteric fractures. The PENG block was performed with the patient in the supine position using ultrasound guidance. Pain scores were measured by numeric rating score (NRS) at rest and with a straight leg raise of the affected limb to 15 degrees before and 30 minutes after block performance.
Results: Totally, 10 patients of ASA Grades II, III and were included who came with peritrochantric hip fracture and were scheduled for gamma nailing. The mean age of the study participants was 77 years. Significantly, pain scores reduced as compared with baseline. No such adverse events were recorded for any of the patients.
Conclusion: In this article the PENG block has been determined to be safe and effective as an anesthetic technique in gamma nailing of peritrochantric fractures but more research in larger-sized studies are needed to better assess the PENG block.
[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.
[2] 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.
[3] Peng P. Reply to Gofeld, pericapsular nerve group (PENG) block: an ethical and academic perspective. Reg Anesth Pain Med. 2019: rapm-2019-100639.
[4] Gofeld M. Pericapsular nerve group (PENG) block: an ethical and academic perspective. Reg Anesth Pain Med. 2019: rapm-2019-100456.
[5] Peng PWH, Perlas A, Chin KJ. Reply to Dr Nielsen: Pericapsular Nerve Group (PENG) block for hip fracture. Reg Anesth Pain Med. 2019; 44(3):415-416.
[6] Fusco P, De Sanctis F, De Paolis V, Di Carlo S, Di Martino E, Volpe D, et al. could Us-guided Peng block pass the icU door? First reported case in a multiple-fracture ICU patient. Minerva Anestesiol. 2020; 86(8):884-885.
[7] Roy R, Agarwal G, Pradhan C, Kuanar D. Total postoperative analgesia for hip surgeries, PENG block with LFCN block. Reg Anesth Pain Med. 2019: rapm-2019-100454.
[8] Orozco S, Muñoz D, Jaramillo S, Herrera AM. Pericapsular Nerve Group (PENG) block for perioperative pain control in hip arthroscopy. J Clin Anesth. 2020; 59:3-4.
[9] Ueshima H, otake H. Pericapsular nerve group (Peng) block is effective for dislocation of the hip joint. J Clin Anesth. 2019; 52:83.
[10] Ince I, Kilicaslan A. Combination of Lumbar Erector Spinae Plane Block (LESP) and Pericapsullar Nerve Group (PENG) block in hip surgery. J Clin Anesth. 2020; 61:109672.
[11] Ince I, Kilicaslan A, Kutlu E, Aydin A. Combined pericapsular nerve block (PENG) and lumbar erector spinae plane (ESP) block for congenital hip dislocation surgery. J Clin Anesth. 2020; 61:109671.
[12] Santos O, Pereira R, Cabral T, Lages N, Machado H. Is continuous peng block the new 3-in-1. J Anesth Clin Res. 2019;10(898):2.
[13] Soares J, Veiga M, Galacho J, Ormonde L. Efficacy of continuous pericapsular nerve group (Peng) block for pain relief after hemiarthroplasty of the hip: a case report. Reg Anesth Pain Med. 2019; 44(1):210.
[14] Orozco S, Muñoz D, Jaramillo S, Herrera AM. Pediatric use of Pericapsular Nerve Group (PENG) block for hip surgical procedures. J Clin Anesth. 2019; 143-144.
[15] Mistry T, Sonawane KB. Gray zone of pericapsular nerve group (PENG) block. J Clin Anesth. 2019; 58:123-124.
[16] Aksu C, Cesur S, Kuş A. Pericapsular nerve group (PENG) block for postoperative analgesia after open reduction of pediatric congenital dysplasia of the hip. J Clin Anesth. 2020; 61:109675.
[17] Fusco P, Di Carlo S, Paladini G, Scimia P, Di Martino E, Marinangeli F, Petrucci E. 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: rapm-2018-100277.
[18] Ueshima H, Otake H. WITHDRAWN: Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. J Clin Anesth. 2018; 51:60-61.
[19] Bilal B, Öksüz G, Boran ÖF, Topak D, Doğar F. High volume pericapsular nerve group (PENG) block for acetabular fracture surgery: A new horizon for novel block. J Clin Anesth. 2020; 62:109702.
[20] 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 Emerg Med. 2020; 38(12):2761.e5-2761.e9.
[21] Sandri M, Blasi A, De Blasi RA. PENG block and LIA as a possible anesthesia technique for total hip arthroplasty. J Anesth. 2020; 34(3):472-475.
[22] Wyatt KE, Pranav H, Henry T, Liu CJ. Pericapsular nerve group blockade for sickle cell disease vaso-occlusive crisis. J Clin Anesth. 2020; 66:109932.
[23] Girón-Arango L, Tran J, Peng PW. A Novel Indication of Pericapsular Nerve Group Block: Surgical Anesthesia for Vein Ligation and Stripping. J Cardiothorac Vasc Anesth. 2020; 34(3):845-846.
[24] Ahiskalioglu A, Aydin ME, Ahiskalioglu EO, Et al. Pericapsular nerve group (PENG) block for surgical anesthesia of medial thigh. J Clin Anesth. 2020; 59:42-43.
[25] Kempf I, Grosse A, Taglang G, Favreul E. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases. Orthop Traumatol Surg Res. 2014; 100(1):75-83.
[26] Chin KJ, Versyck B, Elsharkawy H, Rojas Gomez MF, Sala-Blanch X, Reina MA. Anatomical basis of fascial plane blocks. Reg Anesth Pain Med. 2021; 46(7):581-599.
[27] Chin KJ, Lirk P, Hollmann MW, Schwarz SKW. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med. 2021; 46(7):618-628.
[28] Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol. 2019; 33(4):539-551.
[29] Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. 2019: rapm-2018-000019.
[30] Aydin ME, Borulu F, Ates I, Kara S, Ahiskalioglu A. A Novel Indication of Pericapsular Nerve Group (PENG) Block: Surgical Anesthesia for Vein Ligation and Stripping. J Cardiothorac Vasc Anesth. 2020; 34(3):843-845.
[31] de Leeuw MA, Zuurmond WW, Perez RS. The psoas compartment block for hip surgery: the past, present, and future. Anesthesiol Res Pract. 2011; 2011:159541.
[2] 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.
[3] Peng P. Reply to Gofeld, pericapsular nerve group (PENG) block: an ethical and academic perspective. Reg Anesth Pain Med. 2019: rapm-2019-100639.
[4] Gofeld M. Pericapsular nerve group (PENG) block: an ethical and academic perspective. Reg Anesth Pain Med. 2019: rapm-2019-100456.
[5] Peng PWH, Perlas A, Chin KJ. Reply to Dr Nielsen: Pericapsular Nerve Group (PENG) block for hip fracture. Reg Anesth Pain Med. 2019; 44(3):415-416.
[6] Fusco P, De Sanctis F, De Paolis V, Di Carlo S, Di Martino E, Volpe D, et al. could Us-guided Peng block pass the icU door? First reported case in a multiple-fracture ICU patient. Minerva Anestesiol. 2020; 86(8):884-885.
[7] Roy R, Agarwal G, Pradhan C, Kuanar D. Total postoperative analgesia for hip surgeries, PENG block with LFCN block. Reg Anesth Pain Med. 2019: rapm-2019-100454.
[8] Orozco S, Muñoz D, Jaramillo S, Herrera AM. Pericapsular Nerve Group (PENG) block for perioperative pain control in hip arthroscopy. J Clin Anesth. 2020; 59:3-4.
[9] Ueshima H, otake H. Pericapsular nerve group (Peng) block is effective for dislocation of the hip joint. J Clin Anesth. 2019; 52:83.
[10] Ince I, Kilicaslan A. Combination of Lumbar Erector Spinae Plane Block (LESP) and Pericapsullar Nerve Group (PENG) block in hip surgery. J Clin Anesth. 2020; 61:109672.
[11] Ince I, Kilicaslan A, Kutlu E, Aydin A. Combined pericapsular nerve block (PENG) and lumbar erector spinae plane (ESP) block for congenital hip dislocation surgery. J Clin Anesth. 2020; 61:109671.
[12] Santos O, Pereira R, Cabral T, Lages N, Machado H. Is continuous peng block the new 3-in-1. J Anesth Clin Res. 2019;10(898):2.
[13] Soares J, Veiga M, Galacho J, Ormonde L. Efficacy of continuous pericapsular nerve group (Peng) block for pain relief after hemiarthroplasty of the hip: a case report. Reg Anesth Pain Med. 2019; 44(1):210.
[14] Orozco S, Muñoz D, Jaramillo S, Herrera AM. Pediatric use of Pericapsular Nerve Group (PENG) block for hip surgical procedures. J Clin Anesth. 2019; 143-144.
[15] Mistry T, Sonawane KB. Gray zone of pericapsular nerve group (PENG) block. J Clin Anesth. 2019; 58:123-124.
[16] Aksu C, Cesur S, Kuş A. Pericapsular nerve group (PENG) block for postoperative analgesia after open reduction of pediatric congenital dysplasia of the hip. J Clin Anesth. 2020; 61:109675.
[17] Fusco P, Di Carlo S, Paladini G, Scimia P, Di Martino E, Marinangeli F, Petrucci E. 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: rapm-2018-100277.
[18] Ueshima H, Otake H. WITHDRAWN: Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. J Clin Anesth. 2018; 51:60-61.
[19] Bilal B, Öksüz G, Boran ÖF, Topak D, Doğar F. High volume pericapsular nerve group (PENG) block for acetabular fracture surgery: A new horizon for novel block. J Clin Anesth. 2020; 62:109702.
[20] 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 Emerg Med. 2020; 38(12):2761.e5-2761.e9.
[21] Sandri M, Blasi A, De Blasi RA. PENG block and LIA as a possible anesthesia technique for total hip arthroplasty. J Anesth. 2020; 34(3):472-475.
[22] Wyatt KE, Pranav H, Henry T, Liu CJ. Pericapsular nerve group blockade for sickle cell disease vaso-occlusive crisis. J Clin Anesth. 2020; 66:109932.
[23] Girón-Arango L, Tran J, Peng PW. A Novel Indication of Pericapsular Nerve Group Block: Surgical Anesthesia for Vein Ligation and Stripping. J Cardiothorac Vasc Anesth. 2020; 34(3):845-846.
[24] Ahiskalioglu A, Aydin ME, Ahiskalioglu EO, Et al. Pericapsular nerve group (PENG) block for surgical anesthesia of medial thigh. J Clin Anesth. 2020; 59:42-43.
[25] Kempf I, Grosse A, Taglang G, Favreul E. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases. Orthop Traumatol Surg Res. 2014; 100(1):75-83.
[26] Chin KJ, Versyck B, Elsharkawy H, Rojas Gomez MF, Sala-Blanch X, Reina MA. Anatomical basis of fascial plane blocks. Reg Anesth Pain Med. 2021; 46(7):581-599.
[27] Chin KJ, Lirk P, Hollmann MW, Schwarz SKW. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med. 2021; 46(7):618-628.
[28] Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol. 2019; 33(4):539-551.
[29] Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. 2019: rapm-2018-000019.
[30] Aydin ME, Borulu F, Ates I, Kara S, Ahiskalioglu A. A Novel Indication of Pericapsular Nerve Group (PENG) Block: Surgical Anesthesia for Vein Ligation and Stripping. J Cardiothorac Vasc Anesth. 2020; 34(3):843-845.
[31] de Leeuw MA, Zuurmond WW, Perez RS. The psoas compartment block for hip surgery: the past, present, and future. Anesthesiol Res Pract. 2011; 2011:159541.
| Files | ||
| Issue | Vol 8 No 2 (2022): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i2.9153 | |
| Keywords | ||
| Pain Hip Anesthesia Regional Block | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Espahbodi E, Atef Yekta R, Majedi H, Manafi Rasi A, Shakiba H, Kalani P. Pericapsular Nerve Group (PENG) Block Is a Novel Technique in the Hip Surgery. Arch Anesth & Crit Care. 2022;8(2):129-133.
