Direct visualization-guided PENG block (Pericapsular nerve Group): optimizing postoperative analgesia in total hip arthroplasty

TL;DR

A new technique for a nerve block called PENG-DV helps manage pain after hip replacement surgery, reducing opioid use and aiding early recovery.

Contribution

The study introduces a direct visualization-guided PENG block technique for THA and evaluates its effectiveness in pain control and recovery.

Findings

PENG-DV achieved median VAS scores of 2 and 3 at 12 and 24 hours post-surgery.

83.9% of patients ambulated by postoperative day one with muscle strength ≥3.

54.5% of patients required opioid rescue with a mean morphine equivalent of 10 mg in 24 hours.

Abstract

The pericapsular nerve group (PENG) block has proven to be an effective strategy for postoperative pain management in total hip arthroplasty (THA). However, its implementation requires specialized equipment and expertise, which limits its reproducibility. The objective of this study was to describe the technique of direct visualization-guided PENG block (PENG-DV) and assess its outcomes for postoperative pain control.

A retrospective cohort study was conducted in patients who underwent THA through a direct anterior approach (DAA) and received the PENG-DV block as part of a standardized multimodal analgesia protocol. Demographic variables, pain score on the visual analogue scale (VAS), opioid consumption, muscle strength, and ambulation within the first 24 h were evaluated.

Of the 128 patients identified, 112 were included in the analysis. The cohort was predominantly female (60.7%), with a mean age of 63 years. The median postoperative VAS score was 2 and 3 at 12 and 24 h respectively, increasing to 5 during physical therapy. By postoperative day one, 83.9% of patients ambulated, and most achieved muscle strength ≥ 3 for both hip flexion and knee extension. A total of 54.5% of patients required opioid rescue, with a mean morphine equivalent consumption of 10 mg within the first 24 h.

PENG-DV for THA via DAA appears to be a promising strategy for effective pain control in the immediate postoperative period, as part of a multimodal analgesic approach designed to reduce opioid consumption and promote early mobilization.

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