Abstract
Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described "Pericapsular Nerve Group (PENG) Block" with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0-20] mg and 20 [0-50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.
Highlights
The incidence of femoral neck fracture is 330/10000 per year in Europe
We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or Pericapsular Nerve Group (PENG) block before their surgery
No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay
Summary
The incidence of femoral neck fracture is 330/10000 per year in Europe. It is increasing every year due to the ageing of the population. By 2050, it is estimated that worldwide, more than 4.5 million patients per year will suffer a femoral neck fracture. [1] The healthcare cost is estimated to be $17 billion per year in the United States, related to hospital stay and to rehabilitation, management of complications, and associated disability [2]. A recent Cochrane review pointed out a reduced risk of postoperative complications associated with the use of regional anesthesia (RA), a shorter delay to mobilization, and a reduced morphine consumption in hip fractures, reinforcing the value of postoperative pain control as part of a multimodal management [7]. Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described “Pericapsular Nerve Group (PENG) Block” with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture
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