Abstract
The innervation of the hip joint is complex and it is challenging to provide effective analgesia after hip surgery utilizing any single regional anesthesia technique. The pericapsular nerve group (PENG) block is an interfascial plane block aiming to block articular branches supplied by femoral, obturator, and accessory obturator nerves. In this case series, we compare the efficacy of the PENG block to provide analgesia in primary and revision total hip arthroplasty (THA). The ultrasound-guided PENG block technique is described and post-operative pain scores and opioid requirements are reported. The PENG block was successfully used in primary THA as a solo block, and it may be used in combination with other regional blocks for any hip surgery. The PENG block is an easy regional technique to perform in the supine position with motor-sparing benefits.
Highlights
Total joint replacement is projected to become the most common elective surgical procedure in the coming decade; the prevalence of total hip arthroplasty (THA) was estimated as more than 2.5 million individuals in the entire United States population [1]
Two out of six patients for primary THA was done under spinal anesthesia and rest of the four under general endotracheal tube anesthesia (GETA), and all six out of six patients for revision THA were performed under GETA
In the primary THA group, average pain scores remained lower as compared to the revision THA group at all recorded time points during the study period (Tables 1-2)
Summary
Total joint replacement is projected to become the most common elective surgical procedure in the coming decade; the prevalence of total hip arthroplasty (THA) was estimated as more than 2.5 million individuals in the entire United States population [1]. Osteoporosis and osteoarthritis contribute to the widespread necessity for hip surgery. An estimated two million fractures occur yearly in the United States [2]. THA is the second most common joint replacement surgery. The number and rate of total hip replacements have increased greatly, doubling between 2000 and 2010 [3]. Orthopedic procedures involving the hip have remained challenging for regional anesthesia given the complex innervation, painful nature contributing to difficulty positioning, and a desire to maintain mobility to hasten postoperative recovery
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