PENG Block and Lateral Femoral Cutaneous Nerve Block For Hip Replacement Surgery
Condition: POSTOPERATIVE ANALGESIA
MeSH terms: Agnosia
Study type: Interventional

Summary: 
      Background: this study aimed to describe the pain relief outcomes after hip replacement
      surgery by continuous Pericapsular Nerve Group Block (PENG Block) in combination with lateral
      femoral cutaneous nerve (LFCN) block under the guidance of ultrasound.

      Methods: patients who had hip surgery at E University hospital, Hanoi, Vietnam from August
      2021 to August 2022 belonged to two groups: group of patients with pain relief with PENG
      block in combination with LFCN block (PENG BLOCK group) and group of patients with
      patient-controlled intravenous analgesia (PCA group). Outcomes regarding clinical and pain
      score from initiation of insertion or PCA insertion (H0) to after 72 hours (H72) were
      recorded.
    

Detailed description: 
      First, patients were explained about the study and asked to sign written informed consent if
      they agreed to participate in the study. Next, the patient was instructed to use the visual
      analogue scale (VAS) for pain score, as well as how to press the button to request pain
      relief. Then, a monitor was installed and operated to assess the clinical parameters
      (electrocardiogram, blood pressure, SpO2, arterial blood pressure, temperature). The patient
      was oxygenated 3-5 liters/minute and performed a peripheral intravenous line, with an 18G
      catheter, infused with 0.9% NaCl solution. Spinal anesthesia was administered with
      ropivacaine 0.5% and fentanyl.

      During and after the surgery, a group of patients received intravenous morphine analgesia via
      PCA (concentration 1mg/ml, bolus dose of 1mg, lock time 10 minutes, maximum dose 10mg/4
      hours). The remaining group of patients receive pain relief by PENG block and LFCN block. In
      this group, the ultrasound probe was placed horizontally from the anterior superior iliac
      spine, and was moved along the femoral arc defining the pubic spine. Then, the transducer was
      rotated 45 degrees, moved parallel to the femoral arch identifying the anterior inferior
      iliac spine (AIIS), iliopubic eminence (IPE) and inferior lumbosacral head. The ultrasound
      probe was moved lightly until the upper end of the femoral head was identified. Next, a 120
      mm Tuohy 18G anesthetic needle was used under ultrasound guidance, which was moved lateral to
      medial in the plane between the ultrasound transducer and the superior tip of the femoral
      head. Then, 10 mL of ropivacaine 0.25% was injected through the anesthetic needle tip.

      Data were collected at different times including: before surgery, before anesthesia, during
      surgery and after surgery. The information was recorded in the medical record.

      Preoperative data: the collected information included the general characteristics of the
      study patients including age, gender, weight, height, history of smoking/motion sickness,
      diagnosis, health classification according to ASA, liver and kidney function tests. With
      pre-anesthesia data, information was collected including pulse, blood pressure, respiratory
      rate, SpO2.

      Intraoperative data: the information collected includes information about anesthesia and
      surgical procedure.

      Post-operative data: the collected information includes blood test results (urea, creatinine,
      liver enzymes), pain score (Visual analogue scale - VAS - scale from 0 to 10, the higher the
      score, the higher the pain level. more), analgesic drugs consumption status, respiratory and
      circulatory changes, adverse events, and analgesic satisfaction. Time was recorded from
      initiation of catheterization or PCA insertion (H0) to after 72 hours (H72).
    

Intervention name(s): PERICAPSULAR NERVE GROUP BLOCK COMBINED WITH LATERAL FEMORAL CUTANEOUS NERVE BLOCK
Intervention type(s): Procedure
Intervention description(s): During and after the surgery, a group of patients received intravenous morphine analgesia via PCA (concentration 1mg/ml, bolus dose of 1mg, lock time 10 minutes, maximum dose 10mg/4 hours). The remaining group of patients receive pain relief by PENG block and LFCN block. In this group, the ultrasound probe was placed horizontally from the anterior superior iliac spine, and was moved along the femoral arc defining the pubic spine. Then, the transducer was rotated 45 degrees, moved parallel to the femoral arch identifying the anterior inferior iliac spine (AIIS), iliopubic eminence (IPE) and inferior lumbosacral head. The ultrasound probe was moved lightly until the upper end of the femoral head was identified. Next, a 120 mm Tuohy 18G anesthetic needle was used under ultrasound guidance, which was moved lateral to medial in the plane between the ultrasound transducer and the superior tip of the femoral head. Then, 10 mL of ropivacaine 0.25% was injected through the anesthetic needle tip
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: PCA group and PENG BLOCK group
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Pericapsular Nerve Group Block; lateral femoral cutaneous nerve; multimodal analgesia; ultrasound-guided analgesia; patient-controlled analgesia