Vol 4 | Issue 1 | January-June 2023 | Page 20-25 | Megha Sood, Richa Jain, Gurpreeti Kaur, Amol Rattan, Mirley Rupinder Kaur, Rajnish Garg, Anju Grewal
DOI: https://doi.org/10.13107/ijra.2023.v04i01.070
Authors: Megha Sood [1], Richa Jain [1], Gurpreeti Kaur [1], Amol Rattan [2], Mirley Rupinder Kaur [1], Rajnish Garg [1], Anju Grewal [1]
[1] Department of Anaesthesiology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
[2] Department of Orthopaedics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
Address of Correspondence
Dr. Richa Jain,
Department of Anaesthesiology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
E-mail: richajain2105@gmail.com
Background: The peri-capsular nerve group block (PENG) has reported the ability to decrease pain in hip fractures and minimize the use of opioids for postoperative analgesia. We conducted this trial to assess the efficacy of varying volumes of local anesthetic solution in PENG block in alleviating post-operative pain at rest and on dynamic hip movement after hip surgeries.
Material & Methods: A prospective, double-blinded interventional trial was conducted on 70 adult ASA I-III patients undergoing hip surgeries under general anesthesia. Enrolled subjects were divided into two groups A and B to receive either 10ml of 0.2% ropivacaine or 20ml of 0.2% ropivacaine respectively in an ultrasound-guided (USG) PENG block after administration of general anesthesia. The primary outcome was the duration of analgesia. VAS scores (at rest and on dynamic hip movement), the cumulative amount of rescue analgesic needed in the 24-hour post-operative period and patient satisfaction scores were secondary outcomes. Data thus collected were statistically analyzed.
Results: Mean duration of analgesia was significantly prolonged in group B (12.24±5.14 hours) as compared to group A (2.77±1.06 hours). There were statistically significant decreased VAS scores at rest and on dynamic hip movement in group B. Median total rescue analgesic consumption in 24 hours and patient satisfaction score was significantly reduced in group B than in group A (p=0.001).
Conclusion: In PENG block, 20 ml of 0.2% ropivacaine provides a significantly longer duration of analgesia, a statistically significant reduction in pain scores on rest and dynamic hip movement with substantially decreased 24-hour total rescue analgesic consumption, and improved patient satisfaction in patients undergoing hip surgeries.
Keywords: Pericapsular nerve group block (PENG), Hip surgeries, Ropivacaine, Visual analogue scale (VAS)
References
[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;43:859-63.
[2] 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;46:169-75.
[3] Guay J, Johnson RL, Kopp S. Nerve blocks or no nerve blocks for pain control after elective hip replace- ment (arthroplasty) surgery in adults. Cochrane Database of Systematic Reviews. 2017;10:CD011608.
[4] Mistry T, Sonawane KB, Kuppusamy E. PENG block: points to ponder. Reg Anesth Pain Med.2019;44:423.2–4.
[5] Roy R, Agarwal G, Pradhan C, Kuanar D. Total postoperative analgesia for hip surgeries, PENG block with LFCN block. Reg Anesth Pain Med.2019;44:684.
[6] Rocha Romero A, Carvajal Valdy G, Lemus AJ. Ultrasound- Guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. J Can Anesth.2019;66:1270–1.
[7] Ueshima H, Otake H. Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. J ClinAnesth.2018;51:60–1.
[8] Acharya U, Lamsal R. Pericapsular nerve group block: an excellent option for analgesia for positional pain in hip fractures. Case Rep Anesthesiol.2020;2020:1830136.
[9] Subedi M, Bajaj S, Kumar M, MayurYC. An overview of tramadol and its usage in pain management and future perspective. BiomedPharmacother. 2019;111:443-451.
[10] De Cosmo G, Congedo E. The use of NSAIDs in the postoperative period: advantage and disadvantages. J AnesthCrit Care. 2015;4:1-10.
[11] Scottish intercollegiate Guidelines network. Management of hip fractures in older people: National Clinical Guidelines; 2009. (https://pdf4pro.com/cdn/part-of-nhs-quality-improvement-scotland-2531e4.pdf)
[12] Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth.2011;55:104-10.
[13] 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.
[14] 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;46:169-75.
[15] Mysore K, Sancheti SA, Howells SR, Ballah EE, Sutton JL, Uppal V. Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study. Can J Anaesth. 2020;67:1673-4.
[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;76:1492-8.
[17] 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;46:398-403.
[18] Nielsen MV, Nielsen TD, Bendtsen TF, Børglum J. The Shamrock sign: comprehending the trefoil may refine block execution. Minerva Anestesiologica. 2018;84:1423–5.
How to Cite this Article: Sood M, Jain R, Kaur G, Rattan A, Kaur MR, Garg R, Grewal A | Comparative Evaluation of Varying Volumes of Local Anaesthetic Solution in Pericapsular Nerve Group Block(PENG) on Dynamic Pain Relief after Hip Surgeries | International Journal of Regional Anaesthesia | January-June 2023; 4(1): 20-25 | DOI: https://doi.org/10.13107/ijra.2023.v04i01.070
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