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Enhancing postoperative recovery in total hip arthroplasty: the role of pericapsular nerve group and lateral cutaneous nerve block under spinal anaesthesia

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Abstract

Aim of the study

To compare the efficacy of spinal anaesthesia alone versus spinal anesthesia augmented with ultrasound-guided pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve (LFCN) block in improving perioperative analgesia and functional recovery in patients undergoing THA.

Methods

In a prospective, randomized clinical trial we included 66 patients scheduled for THA were divided into two groups: one receiving spinal anaesthesia alone (SA group; n = 32) and the other receiving spinal anaesthesia with regional analgesia blocks PENG + LFCN (SRAB group; n = 34). In the SRAB group, PENG followed by LFCN blocks were administered under ultrasound guidance before spinal anaesthesia.

Results

There were significant differences between the two groups in the onset of postoperative pain (p < 0.01) and the total amount of analgesics required in the first 36 postoperative hours (p < 0.01).

Conclusion

The combined approach of spinal anaesthesia with PENG and LFCN blockade, enables opioid-free analgesia and may contribute to a safer and more comfortable postoperative experience for THA patients.

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Data availability

All research related materials and data are stored at the Orthopedic Department of the General Hospital Gradiska, Mladen Stojanovic street No 10, Gradiska, Bosnia and Herzegovina.

References

  1. GBD (2019) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study. https://vizhub.healthdata.org/gbd-results/. Accesed 20 February 2024

  2. Pabinger C, Lothaller H, Portner N, Geissler A (2018) Projections of hip arthroplasty in OECD countries up to 2050. Hip Int 28(5):498–506. https://doi.org/10.1177/1120700018757940

    Article  PubMed  Google Scholar 

  3. Sharrock NE, Cazan MG, Hargett MJ, Williams-Russo P, Wilson PD Jr (1995) Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg 80(2):242–248. https://doi.org/10.1097/00000539-199502000-00008

    Article  CAS  PubMed  Google Scholar 

  4. Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A (2018) Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med 43(8):859–863. https://doi.org/10.1097/AAP.0000000000000847

    Article  PubMed  Google Scholar 

  5. Roy R, Agarwal G, Pradhan C, Kuanar D (2019) Total postoperative analgesia for hip surgeries, PENG block with LFCN block. Regional anesthesia and pain medicine rapm-2019–100454. https://doi.org/10.1136/rapm-2019-100454

  6. Girón-Arango L, Roqués V, Peng P (2019) Reply To Dr Roy et al: Total postoperative analgesia for hip surgeries: PENG block with LFCN block. Regional anesthesia and pain medicine rapm-2019–100505. https://doi.org/10.1136/rapm-2019-100505

  7. Chua H, Brady B, Farrugia M, Pavlovic N, Ogul S, Hackett D, Farag D, Wan A, Adie S, Gray L, Nazar M, Xuan W, Walker RM, Harris IA, Naylor JM (2020) Implementing early mobilisation after knee or hip arthroplasty to reduce length of stay: a quality improvement study with embedded qualitative component. BMC Musculoskelet Disord 21(1):765. https://doi.org/10.1186/s12891-020-03780-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gan TJ (2017) Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res 10:2287–2298. https://doi.org/10.2147/JPR.S144066

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Morrison SR, Magaziner J, McLaughlin MA, Orosz G, Silberzweig SB, Koval KJ, Siu AL (2003) The impact of post-operative pain on outcomes following hip fracture. Pain 103(3):303–311. https://doi.org/10.1016/S0304-3959(02)00458-X

    Article  PubMed  Google Scholar 

  10. Duggleby W, Lander J (1994) Cognitive status and postoperative pain: older adults. J Pain Symptom Manage 9(1):19–27. https://doi.org/10.1016/0885-3924(94)90142-2

    Article  CAS  PubMed  Google Scholar 

  11. Kolomachenko V (2021) Eficiency of Pericapsulare nerve group block after hip arthroplasty. Georgian Med News 320:18–22

    Google Scholar 

  12. Patel V, Patel V, Abdallah F, Whelan D, Bansal S, Gabra M, Brull R (2022) The analgesic benefit of Pericapsular Nerve Group (PENG) block in hip arthroscopic surgery: a retrospective pragmatic analysis at an academic health center. Regional anesthesia and pain medicine rapm-2022–103743. https://doi.org/10.1136/rapm-2022-103743

  13. Mauermann WJ, Shilling AM, Zuo Z (2006) A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg 103(4):1018–1025. https://doi.org/10.1213/01.ane.0000237267.75543.59

    Article  PubMed  Google Scholar 

  14. Modig J (1988) Regional anaesthesia and blood loss. Acta Anaesthesiol Scand Suppl 89:44–48. https://doi.org/10.1111/j.1399-6576.1988.tb02842.x

    Article  CAS  PubMed  Google Scholar 

  15. Palija S, Bijeljac S, Manojlovic S, Jovicic Z, Jovanovic M, Cvijic P, Dragicevic-Cvjetkovic D (2021) Effectiveness of different doses and routes of administration of tranexamic acid for total hip replacement. Int Orthop 45(4):865–870. https://doi.org/10.1007/s00264-020-04585-y

    Article  PubMed  Google Scholar 

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Funding

There was no additional costs during implementation of observational study. All costs caused by examinations and analyses are routinely performed to patients who undergo total hip replacement. No financial resources or fees were given to the authors. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

    Anita Djurdjevic Svraka, Dragan Svraka, Stanislav Palija & Slavko Manojlovic

  2. General Hospital Gradiska, Gradiska, Bosnia and Herzegovina

    Anita Djurdjevic Svraka, Dragan Svraka, Aleksandar Milivojac & Rajko Dodik

Authors
  1. Anita Djurdjevic Svraka
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  2. Dragan Svraka
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  3. Aleksandar Milivojac
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  4. Rajko Dodik
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  5. Stanislav Palija
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  6. Slavko Manojlovic
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Contributions

The study conception and design were contributed by Anita Djurdjevic Svraka and Slavko Manojlovic. Material preparation, data collection, and analysis were performed by Anita Djurdjevic Svraka, Dragan Svraka, Aleksandar Milivojac, Rajko Dodik, Slavko Manojlovic, Stanislav Palija. The first draft of the manuscript was written by Anita Djurdjevic Svraka, and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Anita Djurdjevic Svraka.

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Ethics approval

Approval was obtained from the Ethics Committee of General Hospital Gradiska. The Ethics Committee worked exclusively in accordance with the ICH-GCP rules and the latest version of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data and photographs.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Svraka, A.D., Svraka, D., Milivojac, A. et al. Enhancing postoperative recovery in total hip arthroplasty: the role of pericapsular nerve group and lateral cutaneous nerve block under spinal anaesthesia. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06187-4

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  • DOI: https://doi.org/10.1007/s00264-024-06187-4

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