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Prospective Comparative Double-Blind Study on Ultrasound-Guided Pericapsular Nerve Group Block Versus Suprainguinal Fascia Iliaca Block for Perioperative Analgesia in Traumatic Hip Surgeries

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Vol 4 | Issue 1 | January-June 2023 | Page 13-19 | Chetana Bhalerao, Ujjwalraj Dudhedia

DOI: https://doi.org/10.13107/ijra.2023.v04i01.069

Authors: Chetana Bhalerao [1], Ujjwalraj Dudhedia [1]

[1] Department of Anaesthesia, Dr. L.H. Hiranandani Hospital Powai, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Chetana Vitthal Bhalerao,
Department of Anaesthesia, Dr. L.H. Hiranandani Hospital Powai, Mumbai, Maharashtra, India.
E-mail: chetana.bhalerao999@gmail.com

Abstract

Background: Severe pain in hip fractures limits ideal positioning for spinal anaesthesia. We evaluated the analgesic efficacy of ultrasound-guided pericapsular nerve group block (PENG) and suprainguinal fascia iliaca block (SIFI) for positioning and postoperative pain relief in hip surgeries.
Methods: A prospective, randomized, double-blind study including 30 patients aged 30-90 years of either sex, American Society of Anesthesiologists’-physical status score I to II undergoing traumatic hip surgeries were divided into two groups. Each group was administered 20 ml bupivacaine 0.25% + 10 ml lignocaine 1%. Vitals and visual analogue scale (VAS) score pre-block, 10 mins post-block, after shifting to operation theatre and after positioning; at rest, and after straight leg raise (SLR) and quadriceps muscle strength were noted. The remaining aspects of perioperative care, including subarachnoid block and rescue analgesic techniques were standardized. Time to request first rescue analgesia, duration of block, and incidence of nausea was noted. Statistical analysis done using the Student t test, Chi-Square test.
Results: VAS scores in both groups 10 mins post block at rest, after SLR, and after positioning were comparable. The drop in VAS score although statistically insignificant was more in the PENG group. The motor blockade in SIFI was significantly higher compared to the PENG group (p-0.002). Duration of analgesia with SIFI 551.9 (±56.2) min was longer than PENG block 400.4 (±62.8) min (p=0.0005%). No significant difference between the groups to demographics, hemodynamic parameters, rescue analgesia and incidence of nausea.
Conclusion: PENG block provides superior and faster analgesia with potentially motor sparing effect compared to SIFI block whereas SIFI provides longer duration of analgesia.
Keywords: Analgesia, Pain, Regional Anaesthesia, Ultrasonography

References

[1] Shteynberg A, Riina LH, Glickman LT, Meringolo JN, Simpson RL. Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns. 2013;39: 146-9.
[2] Martins RS, M G Siqueira, Silva FC Jr, Heise CO, Teixeira MJ. A practical approach to the lateral cutaneous nerve of the thigh: an anatomical study. Clin Neurol Neurosurg. 2011; 113:868-71.
[3] Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg. 1997;100: 600-4.
[4] Benezis I, Boutaud B, Leclerc J, Fabre T, Durandeau A. Lateral femoral cutaneous neuropathy and its surgical treatment: a report of 167 cases. Muscle Nerve. 2007;36: 659-63.
[5] Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg. 2000;90: 119-24.
[6] Swenson JD, Davis JJ, Stream JO, Crim JR, Burks RT, Greis PE. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. J Clin Anesth. 2015;27: 652-7.
[7] Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120: 1368-1380.
[8] Ueshima H, Otake H. Supra-inguinal fascia iliaca block under ultrasound guidance for perioperative analgesia during bipolar hip arthroplasty in a patient with severe
cardiovascular compromise: A case report. Medicine. 2018; 97(40).
[9] Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018;43: 186-192.
[10] 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.
[11] White S, Stott P. Fascia iliaca block for primary hip arthroplasty. Anaesthesia. 2017;72 :409.
[12] K Shankar, Srinivasan Rangalakshmi, AB Ashwin, et al. Comparative Study of Ultrasound Guided PENG [Pericapsular Nerve Group] Block and FIB [Fascia Iliaca Block] for Positioning and Postoperative Analgesia Prior to Spinal Anaesthesia for Hip Surgeries: Prospective Randomized Comparative Clinical Study. Indian J Anesth Analg.2020;7: 798-803.
[13] Jadon A, Mohsin K, Sahoo RK, Chakraborty S, Sinha N, Bakshi A. Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: A randomised double-blinded trial. Indian J Anaesth. 2021;65: 572-578.
[14]Bhattacharya A, Bhatti T, Haldar M. ESRA19-0539 Pericapsular nerve group block–is it better than the rest for pain relief in fracture neck of femur? Regional Anesthesia and Pain Medicine. 2019; 44(Suppl 1): A116.
[15] Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens Det al. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Regional Anesthesia & Pain Medicine. 2019;44: 483-91.
[16] Gasanova I, Alexander JC, Estrera K, Wells J, Sunna M, Minhajuddin A, Joshi GP. Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2019;44: 206-211.
[17] Ridderikhof ML, De Kruif E, Stevens MF, Baumann HM, Lirk PB, Goslings JC, Hollmann MW. Ultrasound guided supra-inguinal Fascia Iliaca Compartment Blocks in hip fracture patients: An alternative technique. Am J Emerg Med. 2020;38: 231-236.
[18] Bali C, Ozmete O. Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study. Braz J Anesthesiol. 2021: S0104-0014(21)00336-5.
[19] Yamada K, Inomata S, Saito S. Minimum effective volume of ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block. Sci Rep. 2020;10: 21859.
[20] 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: 843-845.

How to Cite this Article: Bhalerao C, Dudhedia U | Prospective Comparative Double-Blind Study on Ultrasound- Guided Pericapsular Nerve Group Block Versus Suprainguinal Fascia Iliaca Block for Perioperative Analgesia in Traumatic Hip Surgeries | International Journal of Regional Anaesthesia | January-June 2023; 4(1): 13-19 | DOI:https://doi.org/10.13107/ijra.2023.v04i01.069

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Time to adequately heed Acute Pain in the Emergency Department – More Regional Blocks Warranted

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Vol 3 | Issue 2 | July-December 2022 | Page 37-41 | Tom C. R. V. Van Zundert, André A. J. Van Zundert

DOI: 10.13107/ijra.2022.v03i02.054

Authors: Tom C. R. V. Van Zundert [1, 2], André A. J. Van Zundert [2, 3]

[1] Department of Emergency Medicine, Holy Heart Hospital, Mol, Belgium.
[2] Udayana University, Bali, Indonesia.
[3] Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia.

Address of Correspondence
Professor André A.J. Van Zundert,
Professor and Chair of Anaesthesiology, Royal Brisbane and Women’s Hospital & The University of Queensland, Brisbane, QLD, Australia.
E-mail: vanzundertandre@gmail.com

Introduction

All healthcare stressors converge in the emergency department (ED), which sees an annual increase of 6-7% with more than 25 million patient visits in the UK. This translates to 44,435 attendances per 100,000 population in the period 2019-2020 [1]. Acute pain is the primary reason patients seek emergency medical care. Consequently, substandard acute pain treatment is one of the most frequently heard complaints and has been labelled as a public health problem [2]. Pain remains under-acknowledged, -assessed and -treated, mainly in case of overcrowding in the ED and especially in the more vulnerable groups, including the elderly and children. Many patients express an initial pain score of 10 out of 10 on the visual analogue scale (VAS) in the ED. Generally, initial pain treatment combines oral acetaminophen, NSAID and/or (IV) opioids. Nevertheless, despite these pain killers, most patients continue to suffer and score their pain at 8/10 or higher. Untreated pain can have both short- and long-term effects, including sensitisation to pain episodes in later life [3].

Most visits to the emergency department involve patients with conditions that include: a) injuries and trauma from (motor vehicle) accidents, physical assaults or falls, with or without circulatory shock; b) cardiovascular and cerebral attacks or loss of consciousness; c) severe pain of diverse causes, both acute and chronic origin; d) acute worsening of a serious illness or disease, including problems with breathing and bleeding; e) mental illness; f) burns; g) anaphylactic and allergic reactions; g) drug overdoses and poisoning; and h) pregnancy-related complications. In most of these cases, patients present with pain as a substantial factor.

Keywords: Emergency department, Hip fracture, Pain, Regional anaesthesia, Nerve blocks, Ultrasonography

References

1. NHS Report. Hospital Accident & Emergency Activity 2020-21. 30.09.2021. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident–emergency-activity/2020-21# (accessed 20.05.2022).
2. Keating L, Smith S. Acute Pain in the Emergency Department: The Challenges. Rev Pain. 2011;5(3):13-17.
3. Duggan NM, Nagdev A, Hayes BD, Shokoohi H, Selame LA, Liteplo AS, Goldsmith AJ. Perineural Dexamethasone as a Peripheral Nerve Block Adjuvant in the Emergency Department: A Case Series. J Emerg Med. 2021 Nov;61(5):574-580.
4. Verbeek T, Adhikary S, Urman R, Liu H. The Application of Fascia Iliaca Compartment Block for Acute Pain Control of Hip Fracture and Surgery. Curr Pain Headache Rep. 2021 Mar 11;25(4):22.
5. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury 2018;49:1458-1460.
6. Amin NH, West JA, Farmer T, Basmajian HG. Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy. Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):268-275.
7. Salottolo K, Meinig R, Fine L, Kelly M, Madayag R, Ekengren F, Tanner A, Roman P, Bar-Or D. A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture. Trauma Surgery & Acute Care Open 2022;7:e000904.
8. Hao J, Dong B, Zhang J, Luo Z. Pre-emptive analgesia with continuous fascia iliaca compartment block reduces postoperative delirium in elderly patients with hip fracture. A randomized controlled trial. Saudi Med J. 2019 Sep;40(9):901-906.
9. Lee HK, Kang BS, Kim CS, Choi HJ. Ultrasound-guided regional anaesthesia for the pain management of elderly patients with hip fractures in the emergency department. Clin Exp Emerg Med. 2014 Sep 30;1(1):49-55.
10. Hards M, Brewer A, Bessant G, Lahiri S. Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review. Prehosp Disaster Med. 2018 Jun;33(3):299-307.
11. Okereke IC, Abdelmonem M. Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit. Cureus. 2021;13:e17836. doi: 10.7759/cureus.17836
12. Nice Guidelines. The management of hip fracture in adults. Updated 2019. https://www.nice.org.uk/guidance/cg124/evidence/full-guideline-pdf-183081997 (accessed 24.05.2022).
13. Butler MM, Ancona RM, Beauchamp GA, Yamin CK, Winstanley EL, Hart KW, Ruffner AH, Ryan SW, Ryan RJ, Lindsell CJ, Lyons MS. Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction. Ann Emerg Med. 2016 Aug;68(2):202-8.
14. Ketelaars R, Stollman JT, van Eeten E, Eikendal T, Bruhn J, van Geffen G-J. Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands. Int J Emerg Med 2018;11:12.
15. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689.
16. Nagel EM, Gantioque R, Taira T. Utilizing Ultrasound-Guided Femoral Nerve Blocks and Fascia Iliaca Compartment Blocks for Proximal Femur Fractures in the Emergency Department. Adv Emerg Nurs J. 2019 Apr/Jun;41(2):135-144.
17. Luftig J, Mantuani D, Herring AA, Dixon B, Clattenburg E, Nagdev A. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med. 2018 Aug;36(8):1391-1396.
18. Ritcey B, Pageau P, Woo MY, Perry JJ. Regional Nerve Blocks For Hip and Femoral Neck Fractures in the Emergency Department: A Systematic Review. CJEM. 2016 Jan;18(1):37-47.
19. Jaffe TA, Shokoohi H, Liteplo A, Goldsmith A. A Novel Application of Ultrasound-Guided Interscalene Anaesthesia for Proximal Humeral Fractures. The Journal of Emergency Medicine. 2020;59:265-269.
20. De Buck F, Devroe S, Missant C, Van de Velde M. Regional anaesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7.
21. Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018 Jun;120(6):1368-1380.
22. Scarpa J, Wu CL. The role for regional anaesthesia in medical emergencies during deep space flight. Reg Anesth Pain Med. 2021 Oct;46(10):919-922.
23. Cappelleri G, Fanelli A, Ghisi D, Russo G, Giorgi A, Torrano V, Lo Bianco G, Salomone S, Fumagalli R. The Role of Regional Anaesthesia During the SARS-CoV2 Pandemic: Appraisal of Clinical, Pharmacological and Organizational Aspects. Front Pharmacol. 2021 Jun 4;12:574091.
24. Wiercigroch D, Ben-Yakov M, Porplycia D, Friedman SM. Regional anaesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use. CJEM. 2020 Jul;22(4):499-503.
25. Herring AA. Bringing Ultrasound-guided Regional Anaesthesia to Emergency Medicine. AEM Educ Train. 2017 Mar 29;1(2):165-168.

How to Cite this Article: Van Zundert TCRV, Van Zundert AAJ | Time to Adequately Heed Acute Pain in the Emergency Department- More Regional Blocks Warranted | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 37-41.

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