Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.07.007
Brazilian Journal of Anesthesiology
Systematic Review

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Bloqueio do Grupo do Nervo Pericapsular (BGNP) versus bloqueio do compartimento da fáscia ilíaca (FI) para cirurgia de quadril: uma revisão sistemática e meta-análise de ensaios clínicos randomizados

Priscila P. Andrade, Rafael A. Lombardi, Isabela R. Marques, Anna Carla Di Napoli Andrade e Braga, Beatrice R.S. Isaias, Nicholas E. Heiser

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Abstract

Background
This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery.

Methods
Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations.

Results
Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6h or 24h post-surgery, or in the time to the first analgesic rescue after surgery.

Conclusion
The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block.

Keywords

PENG block Pericapsular nerve group block Fascia iliaca block Hip surgery Hip replacement Meta-analysis

Resumo

Introdução

Este estudo compara o bloqueio do compartimento da fáscia iliaca (FI) e o bloqueio do grupo do nervo pericapsular (BGNP) para cirurgia de quadril.

Métodos

Pubmed, Embase e Cochrane foram pesquisados sistematicamente em abril de 2022. Os critérios de inclusão foram: ensaios clínicos randomizados (ECR); comparando bloqueio GNP versus bloqueio FI para cirurgia de quadril; pacientes maiores de 18 anos; e relatar resultados imediatamente pós-operatórios. Excluímos estudos com populações sobrepostas e sem comparação direta entre o bloqueio GNP e o bloqueio FI. Diferença Média (MD) com Intervalos de Confiança (IC) de 95% foram agrupados. Análises Sequenciais de Ensaio (ASE) foram realizadas para avaliar a inconsistência. A avaliação da qualidade e do risco de viés foram realizadas de acordo com as recomendações da Cochrane.

Resultados

Foram incluídos oito ECRs compreendendo 384 pacientes, dos quais 196 (51%) foram submetidos ao bloqueio GNP. Após cirurgia de quadril, o bloqueio GNP reduziu o escore de dor estática 12h após a cirurgia (MD = 0,61 mm; IC 95% 1,12 a -0,09; p = 0,02) e o consumo cumulativo de morfina oral pós-operatória nas primeiras 24h (MD = -6,93 mg; IC 95% -13,60 a -0,25; p = 0,04) em comparação com o grupo FI. No entanto, não foram encontradas diferenças entre as duas técnicas em relação aos escores de dor dinâmica e estática às 6 horas ou 24 horas pós-operatória, ou no tempo até o primeiro resgate analgésico após a cirurgia.

Conclusão

Os resultados sugerem que o bloqueio GNP reduziu o consumo de opioides nas primeiras 24 horas após a cirurgia e reduziu os escores de dor em repouso 12 horas após a cirurgia. Mais pesquisas são necessárias para compreender completamente os efeitos do bloqueio GNP e seus benefícios potenciais em comparação com o bloqueio FI.

Cadastro PROSPERO

CRD42022339628

Palavras-chave

Bloqueio GNP; Bloqueio do grupo nervoso pericapsular; Bloqueio da fáscia ilíaca; Cirurgia de quadril; Artroplastia de quadril; Meta-análise

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Submitted date:
11/22/2022

Accepted date:
07/16/2023

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