Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Effects of pericapsular nerve group block on patients under spinal anesthesia for total hip arthroplasty: a randomized, controlled, double-blind study
1Department of Anaesthesia and Reanimation, Umraniye Training and Research Hospital, University of Health Sciences, 34764 Istanbul, Turkey
2Department of Algology, Umraniye Training and Research Hospital, University of Health Sciences, 34764 Istanbul, Turkey
DOI: 10.22514/sv.2025.045
Submitted: 07 May 2024 Accepted: 24 September 2024
Online publish date: 26 March 2025
*Corresponding Author(s): Zeliha Tuncel E-mail: zeliha.tuncel@sbu.edu.tr
Background: This study aimed to evaluate the Pericapsular Nerve Group (PENG) Block applied for anesthesia in total hip arthroplasty (THA) surgery regarding its effects on postoperative pain, opioid requirement and early mobilization. Methods: This prospective, randomized, controlled study was included a total of 60 patients who underwent THA under spinal anesthesia. The patients were divided into two groups: those receiving the PENG block and others not receiving the PENG block. The primary outcome was assessing postoperative pain with Visual analogue scales (VAS). Secondary outcomes included postoperative adverse effects, hip joint range of motion, mobilisation, total opioid requirement and length of hospital stay. Results: In the PENG group, the VAS score at the 12th, 24th and 48th hours after the procedure, total opioid requirement, and the time to mobilization were significantly lower than those in the control group (p < 0.01). In the PENG group, the time to additional analgesic administration was significantly longer, and the hip joint range of motion was significantly higher compared to the control group (p < 0.01). There was no significant difference between the groups regarding the length of hospital stay (p > 0.05). Conclusions: Our study indicated a decrease in postoperative pain and total opioid consumption in patients undergoing PENG block application. It was observed that these patients had a later requirement for initial additional analgesia and greater hip joint range of motion, and they required a shorter time for mobilization. It has been concluded that the PENG block could be an effective and safe analgesic method as a significant part of multimodal analgesia in postoperative pain control in THA surgery. Clinical Trial Registration: NCT06183528.
Anaesthesia; Arthroplasty; Hip surgery; Postoperative pain; Pericapsular nerve group block
Dicle Deri Turkan,Zeliha Tuncel,Hale Arkan Tuna. Effects of pericapsular nerve group block on patients under spinal anesthesia for total hip arthroplasty: a randomized, controlled, double-blind study. Signa Vitae. 2025.doi:10.22514/sv.2025.045.
[1] Bober K, Kadado A, Charters M, Ayoola A, North T. Pain control after total hip arthroplasty: a randomized controlled trial determining efficacy of fascia iliaca compartment blocks in the immediate postoperative period. The Journal of Arthroplasty. 2020; 35: s241–s245.
[2] Højer Karlsen AP, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: a systematic review. PAIN. 2015; 156: 8–30.
[3] Zhao J, Davis SP. An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty. International Journal of Nursing Studies. 2019; 98: 94–106.
[4] Andersen KV, Pfeiffer-Jensen M, Haraldsted V, Søballe K. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients. Acta Orthopaedica. 2007; 78: 180–186.
[5] Chen DW, Hu C, Chang Y, Lee MS, Chang C, Hsieh P. Intra-articular bupivacaine reduces postoperative pain and meperidine use after total hip arthroplasty: a randomized, double-blind study. The Journal of Arthroplasty. 2014; 29: 2457–2461.
[6] Cui Y, Yang T, Zeng C, Wei J, Xie X, Li L, et al. Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies. BMJ Open. 2016; 6: e011325.
[7] Lindenhovius AL, Helmerhorst GT, Schnellen AC, Vrahas M, Ring D, Kloen P. Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and the Netherlands. Journal of Trauma and Acute Care Surgery. 2009; 67: 160–164.
[8] Shah R, Kuo YF, Westra J, Lin YL, Raji MA. Opioid use and pain control after total hip and knee arthroplasty in the USA, 2014 to 2017. JAMA Network Open. 2020; 3: e2011972.
[9] Gaffney CJ, Pelt CE, Gililland JM, Peters CL. Perioperative pain management in hip and knee arthroplasty. Orthopedic Clinics of North America. 2017; 48: 407–419.
[10] Pepper AM, Mercuri JJ, Behery OA, Vigdorchik JM. Total hip and knee arthroplasty perioperative pain management. JBJS Reviews. 2018; 6: e5.
[11] Jaeger P, Nielsen ZJ, Henningsen MH, Hilsted KL, Mathiesen O, Dahl JB. Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. Anesthesiology. 2013; 118: 409–415.
[12] 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. Regional Anesthesia & Pain Medicine. 2021; 46: 398–403.
[13] Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Regional Anesthesia & Pain Medicine. 2018; 43: 859–863.
[14] Del Buono R, Padua E, Pascarella G, Costa F, Tognù A, Terranova G, et al. Pericapsular nerve group (PENG) block: an overview. Minerva Anestesiologica. 2021; 87: 458–466.
[15] Sahoo RK, Jadon A, Sharma SK, Nair AS. Pericapsular nerve group (PENG) block for hip fractures: another weapon in the armamentarium of anesthesiologists. Journal of Anaesthesiology Clinical Pharmacology. 2021; 37: 295–296.
[16] Pascarella G, Costa F, Del Buono R, Pulitanò R, Strumia A, Piliego C, et al. 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: 1492–1498.
[17] 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; 12: e8200.
[18] Zheng J, Pan D, Zheng B, Ruan X. Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial. Regional Anesthesia & Pain Medicine. 2022; 47: 155–160.
[19] Lin DY, Morrison C, Brown B, Saies A, Pawar R, Vermeulen M, et al. In reply to: ‘towards precision regional anesthesia: is the PENG block appropriate for all hip fracture surgeries?’ Regional Anesthesia & Pain Medicine. 2022; 47: 77–78.
[20] 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. Regional Anesthesia & Pain Medicine. 2021; 46: 169–175.
[21] Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021; 76: 1082–1097.
[22] Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118: 934–944.
[23] Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare. 2021; 9: 333.
[24] 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. Regional Anesthesia & Pain Medicine. 2021; 46: 874–878.
[25] Mosaffa F, Taheri M, Manafi Rasi A, Samadpour H, Memary E, Mirkheshti A. Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: a double-blind prospective randomized controlled clinical trial. Orthopaedics & Traumatology: Surgery & Research. 2022; 108: 103135.
[26] 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: e28872.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.
Top