Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective s
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CORRESPONDENCE
Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study Kiran Mysore, MD . Sushil A. Sancheti, MD FRCPC . Steven R. Howells, MD FRCPC . Erin E. Ballah, MSc . Jennifer L. Sutton, MN . Vishal Uppal, MBBS MSc FRCA
Received: 25 May 2020 / Revised: 12 June 2020 / Accepted: 6 July 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, The pericapsular nerve group (PENG) block, which targets sensory branches of the obturator, accessory obturator, and femoral nerves in the anterior capsule of the hip, has been proposed as an effective method to treat pain associated with hip fractures and total hip arthroplasty (THA).1 The PENG block provides coverage of the sensory nerves supplying the anterior hip2 while sparing motor blockade of the quadriceps; a known complication of fascia iliaca and femoral blocks.3 We began an Enhanced Recovery After Surgery program for joint arthroplasty in September 2018 and the PENG block was introduced in an attempt to improve quality of recovery. A survey of the American Association of Hip and Knee Surgeons showed periarticular local infiltration anesthesia (LIA) is used in 80.3% of THA patients.4 We anticipated that adding a PENG block to LIA, rather than replacing it, would gain easier acceptance from both surgeons and anesthesiologists. We present the findings of our retrospective review that compares the analgesic benefit of adding PENG block to LIA and multimodal analgesia in THA.
K. Mysore, MD S. A. Sancheti, MD FRCPC (&) S. R. Howells, MD FRCPC Department of Anesthesia, Memorial University, St. John’s, NL, Canada e-mail: [email protected] E. E. Ballah, MScJ. L. Sutton, MN Perioperative Division, Eastern Health, St. John’s, NL, Canada V. Uppal, MBBS MSc FRCA Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie, Halifax, NS, Canada
After Newfoundland and Labrador Human Research Ethics Board approval in November 2019, an historical cohort study was conducted among all patients who had THA from October 2018 to October 2019 at the Health Sciences Centre in St. John’s, Newfoundland, Canada. Published research suggested periarticular infiltration reduced 24-hr hydromorphone consumption from 43.3 to 28.5 mg (pooled standard deviation [SD], 22).5 A study with 36 participants per group would detect a difference of this size with probability of alpha and beta errors of 0.05 and 0.20, respectively. We chose a time interval that included at least 36 completed PENG blocks. Patients with preoperative opioid tolerance, or those who received intrathecal morphine, fascia iliaca block, or postoperative epidural infusion were excluded. We identified 123 patients who met the inclusion criteria; 47 received and 76 did not receive PENG block. The data for all eligible patients was retrieved from the anesthesia charting system and their electronic medical record. The PENG block was performed as in the original description1 by injecting 20 mL of 0.25% bupivacaine with 1:200,000 epinephrin
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