medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2023, Number 1

<< Back Next >>

Acta Med 2023; 21 (1)

Quality of postoperative analgesia with PENG blockade under general anesthesia vs. spinal anesthesia in hip surgery patients

Céspedes KMÁ, Zaragoza LG, Portela OJM, Bracho BE, Picazo CR

Language: Spanish
References: 29
Page: 16-21
PDF size: 188.08 Kb.


ABSTRACT

Introduction: the PENG block has been shown to offer effective analgesia in hip surgery. Traditional opioid analgesia is associated with high-impact side effects in the evolution of postoperative outcomes. We report the quality of postoperative analgesia in two settings: general anesthesia and spinal anesthesia plus regional anesthesia, showing similar efficacy and safety. Material and methods: 60 consecutive patients were collected: group 1 general anesthesia plus PENG and group 2 spinal anesthesia plus PENG. Passive and active pain scores were recorded in the preoperative period, PICU, at 6, 12, 18, and 24 hours. Results: the mean pain score for both groups in the postoperative period was 2.0-1.0 on the VAS scale at 24 hours. 81.7% of the patients did not require additional analgesia to the basic analgesic scheme; the 18.3% of patients who required analgesic rescue were of the NSAID type; 70% of them were 12 hours after the placement of the PENG block. 95% of patients were satisfied with postoperative analgesia. Conclusion: PENG block is associated with a high analgesic success rate in hip surgery and a low incidence of complications; can be considered a safe alternative in the multimodal scheme.


REFERENCES

  1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302 (14): 1573-1579.

  2. Neuman MD, Fleisher LA, Even-Shoshan O, Mi L, Silber JH. Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities. Med Care. 2010; 48 (4): 314-320.

  3. Urbano FL, Pascual RM. Contemporary issues in the care of patients with chronic obstructive pulmonary disease. J Manag Care Pharm. 2005; 11 (5 Suppl A): S2-13; quiz S14-S16.

  4. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL et al. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002; 55 (8): 809-817.

  5. Dowsey MM, Gunn J, Choong PF. Selecting those to refer for joint replacement: who will likely benefit and who will not? Best Pract Res Clin Rheumatol. 2014; 28 (1): 157-171.

  6. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10: 2287-2298.

  7. Buvanendran A, Della Valle CJ, Kroin JS, Shah M, Moric M et al. Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study. Reg Anesth Pain Med. 2019; 44 (3): e100036.

  8. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012; 2 (1): e000435.

  9. Sibia US, Mandelblatt AE, Caleb Alexander G, King PJ, MacDonald JH. Opioid prescriptions after total joint arthroplasty. J Surg Orthop Adv. 2018; 27 (3): 231-236.

  10. Konishi Y, Evered LA, Scott DA, Silbert BS. Postoperative cognitive dysfunction after sevoflurane or propofol general anaesthesia in combination with spinal anaesthesia for hip arthroplasty. Anaesth Intensive Care. 2018; 46 (6): 596-600.

  11. Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005; 441: 250-255.

  12. Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral nerve blocks for hip fractures: a Cochrane review. Anesth Analg. 2018; 126 (5): 1695-1704.

  13. Wang X, Sun Y, Wang L, Hao X. Femoral nerve block versus fascia iliaca block for pain control in total knee and hip arthroplasty: A meta-analysis from randomized controlled trials. Medicine (Baltimore). 2017; 96 (27): e7382.

  14. Fei D, Ma LP, Yuan HP, Zhao DX. Comparison of femoral nerve block and fascia iliaca block for pain management in total hip arthroplasty: A meta-analysis. Int J Surg. 2017; 46: 11-13.

  15. Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A et al. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012; 22 (1): 75-81.

  16. Bugada D, Bellini V, Lorini LF, Mariano ER. Update on selective regional analgesia for hip surgery patients. Anesthesiol Clin. 2018; 36 (3): 403-415.

  17. Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K et al. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. Reg Anesth Pain Med. 2018; 43 (2): 186-192.

  18. 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): 859-863.

  19. Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010; 105 Suppl 1: i97-i107.

  20. Mysore K, Sancheti SA, Howells SR, Ballah EE, Sutton JL et al. Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study. Can J Anaesth. 2020; 67 (11): 1673-1674.

  21. Remily EA, Hochstein SR, Wilkie WA, Mohamed NS, Thompson JV, Kluk MW et al. The pericapsular nerve group block: a step towards outpatient total hip arthroplasty? Hip Int. 2022; 32 (3): 318-325.

  22. Singh S, Singh S, Ahmed W. Continuous pericapsular nerve group block for hip surgery: a case series. A A Pract. 2020; 14 (11): e01320.

  23. Del Buono R, Padua E, Pascarella G, Soare CG, Barbara E. Continuous PENG block for hip fracture: a case series. Reg Anesth Pain Med. 2020; 45 (10): 835-838.

  24. 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 (5): e8200.

  25. Luftig J, Dreyfuss A, Mantuani D, Howell K, White A et al. A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block. Am J Emerg Med. 2020; 38 (12): 2761.e5-2761.e9.

  26. Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021; 385 (22): 2025-2035. doi: 10.1056/NEJMoa2113514.

  27. Flores Cadena LE, Athié García JM. Bloqueo de Pericapsular Nerve Group en cirugía de cadera. Experiencia analgésica perioperatoria. Acta Méd Grupo Ángeles. 2021; 19 (4): 480-484.

  28. Zaragoza-Lemus G, Céspedes-Korrodi MA, Hernández-Rodríguez D, Mancera-Rangel M. Colocación de catéter ecoguiado para bloqueo PENG continuo en cirugía de cadera. Rev Mex Anestesiol. 2021; 44 (3): 233-236.

  29. Hoffmann JD, Kusnezov NA, Dunn JC, Zarkadis NJ, Goodman GP et al. The shift to same-day outpatient joint arthroplasty: a systematic review. J Arthroplasty. 2018; 33 (4): 1265-1274.




2020     |     www.medigraphic.com