Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series.
Hip fracture
Pericapsular nerve group block
Posterior hip pericapsular block
Regional anesthesia
Total hip arthroplasty
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
23
06
2024
accepted:
16
09
2024
medline:
2
10
2024
pubmed:
2
10
2024
entrez:
1
10
2024
Statut:
epublish
Résumé
Pain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function. This case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded. They experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients. Ultrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.
Sections du résumé
BACKGROUND
BACKGROUND
Pain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function.
METHODS
METHODS
This case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded.
RESULTS
RESULTS
They experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients.
CONCLUSIONS
CONCLUSIONS
Ultrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.
Identifiants
pubmed: 39354374
doi: 10.1186/s12871-024-02731-2
pii: 10.1186/s12871-024-02731-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
352Informations de copyright
© 2024. The Author(s).
Références
Abraham DS, Barr E, Ostir GV, Hebel JR, Golden J, Gruber-Baldini AL, Guralnik JM, Hochberg MC, Orwig DL, Resnick B, et al. Residual disability, mortality, and nursing home Placement after hip fracture over 2 decades. Arch Phys Med Rehabil. 2019;100(5):874–82.
doi: 10.1016/j.apmr.2018.10.008
pubmed: 30391413
Sun L, Wang C, Zhang M, Li X, Zhao B. The Surgical timing and prognoses of Elderly patients with hip fractures: a retrospective analysis. Clin Interv Aging. 2023;18:891–9.
doi: 10.2147/CIA.S408903
pubmed: 37287528
pmcid: 10243344
Memtsoudis SG, Fiasconaro M, Soffin EM, Liu J, Wilson LA, Poeran J, Bekeris J, Kehlet H. Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study. Br J Anaesth. 2020;124(5):638–47.
doi: 10.1016/j.bja.2020.01.017
pubmed: 32139134
Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, Raeder J, Group* PW, Anaesthesia tESoR, Therapy P, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(8):1082–97.
Tran J, Peng PWH, Lam K, Baig E, Agur AMR, Gofeld M. Anatomical study of the innervation of anterior knee Joint Capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(4):407–14.
doi: 10.1097/AAP.0000000000000778
pubmed: 29557887
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):859–63.
pubmed: 30063657
Lin X, Liu CW, Goh QY, Sim EY, Chan SKT, Lim ZW, Chan DXH. Pericapsular nerve group (PENG) block for early pain management of elderly patients with hip fracture: a single-center double-blind randomized controlled trial. Reg Anesth Pain Med. 2023;48(11):535–9.
doi: 10.1136/rapm-2022-104117
pubmed: 37055189
Duan L, Zhang L, Shi C-G, Huang L-G, Ao H, Wang Z-P, Deng Y, Sun M-L. Comparison of continuous pericapsular nerve group (PENG) block versus continuous fascia iliaca compartment block on pain management and quadriceps muscle strength after total hip arthroplasty: a prospective, randomized controlled study. BMC Anesthesiol. 2023;23(1):233.
doi: 10.1186/s12871-023-02190-1
pubmed: 37434138
pmcid: 10334586
Tomlinson J, Ondruschka B, Prietzel T, Zwirner J, Hammer N. A systematic review and meta-analysis of the hip capsule innervation and its clinical implications. Sci Rep. 2021;11(1):5299.
doi: 10.1038/s41598-021-84345-z
pubmed: 33674621
pmcid: 7935927
Ng TK-T, Peng P, Chan W-S. Posterior hip pericapsular neurolysis (PHPN) for inoperable hip fracture: an adjunct to anterior hip pericapsular neurolysis. Reg Anesth Pain Med. 2021;46(12):1080–4.
doi: 10.1136/rapm-2021-103023
pubmed: 34686579
Nielsen MV, Nielsen TD, Bendtsen TF, Børglum J. The Shamrock sign: comprehending the trefoil may refine block execution. Minerva Anestesiol. 2018;84(12):1423–5.
doi: 10.23736/S0375-9393.18.13092-6
pubmed: 30328331
Fusco P, Cofini V, Petrucci E, Scimia P, Fiorenzi M, Paladini G, Behr AU, Borghi B, Flamini S, Pizzoferrato R, et al. Continuous wound infusion and local infiltration analgesia for postoperative pain and rehabilitation after total hip arthroplasty. Minerva Anestesiol. 2018;84(5):556–64.
doi: 10.23736/S0375-9393.17.12110-3
pubmed: 28984095
Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, Vangsness CT. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22(1):75–81.
doi: 10.5301/HIP.2012.9042
pubmed: 22344482
Birnbaum K, Prescher A, Hessler S, Heller KD. The sensory innervation of the hip joint–an anatomical study. Surg Radiol Anat. 1997;19(6):371–5.
doi: 10.1007/BF01628504
pubmed: 9479711
Laumonerie P, Dalmas Y, Tibbo ME, Robert S, Durant T, Caste T, Vialla T, Tiercelin J, Gracia G, Chaynes P. Sensory innervation of the Hip Joint and Referred Pain: a systematic review of the literature. Pain Med. 2021;22(5):1149–57.
doi: 10.1093/pm/pnab061
pubmed: 33565587
Nagpal AS, Brennick C, Occhialini AP, Leet JG, Clark TS, Rahimi OB, Hulk K, Bickelhaupt B, Eckmann MS. Innervation of the posterior hip Capsule: a cadaveric study. Pain Med. 2021;22(5):1072–9.
doi: 10.1093/pm/pnab057
pubmed: 33565591
Tulgar S, Selvi O, Senturk O, Unal OK, Thomas DT, Ozer Z. The Maltepe combination: novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia in transfemoral knee amputation. J Clin Anesth. 2019;57:95–6.
doi: 10.1016/j.jclinane.2019.03.024
pubmed: 30939421
Vermeylen K, Van Aken D, Versyck B, Casaer S, Bleys R, Bracke P, Groen G. Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study. BJA Open. 2023;5:100127.
doi: 10.1016/j.bjao.2023.100127
pubmed: 37587997
pmcid: 10430842
Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Regional anesthesia and pain medicine, 2019;44(2): 257–257.
Leurcharusmee P, Kantakam P, Intasuwan P, Malatong Y, Maikong N, Navic P, Kitcharanant N, Mahakkanukrauh P, Tran DQ. Cadaveric study investigating the femoral nerve-sparing volume for pericapsular nerve group (PENG) block. Reg Anesth Pain Med. 2023;48(11):549–52.
doi: 10.1136/rapm-2023-104419
pubmed: 37028817
Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014;89(1):27–34.
pubmed: 24444505
Chamberlain R. Hip Pain in adults: evaluation and Differential diagnosis. Am Fam Physician. 2021;103(2):81–9.
pubmed: 33448767
Park JW, Lee Y-K, Lee YJ, Shin S, Kang Y, Koo K-H. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J. 2020;102–B(5):556–67.
doi: 10.1302/0301-620X.102B5.BJJ-2019-1212.R1
pubmed: 32349600
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. Orthop Traumatol Surg Res. 2022;108(1):103135.
doi: 10.1016/j.otsr.2021.103135
pubmed: 34715388
Kukreja P, Uppal V, Kofskey AM, Feinstein J, Northern T, Davis C, Morgan CJ, Kalagara H. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. Br J Anaesth. 2023;130(6):773–9.
doi: 10.1016/j.bja.2023.02.017
pubmed: 36964012