Pericapsular Nerve Group (PENG) Block: Is It an Analgesic Alternative to Lumbar Plexus Block in Pediatric Hip Surgery?

Abstract

Title: Pericapsular Nerve Group (PENG) Block: Is It an Analgesic Alternative to Lumbar Plexus Block in Pediatric Hip Surgery?

Authors: Jacqueline Morales¹, David Campos², Ramiro Cuevas³, Zulia Portillo⁴, Salma De La O⁵

1.        Head of the Anesthesiology Division, National Institute of Rehabilitation

2.        Director of the Evening Diploma Course in Regional Anesthesia, National Institute of Rehabilitation

3.        Staff Orthopedic Surgeon, Pediatric Orthopedics Department, National Institute of Rehabilitation

4.        Regional Anesthesiologist

5.        Senior Resident in the Regional Anesthesia Fellowship, National Institute of Rehabilitation

Keywords: regional anesthesia, pediatric anesthesia, PENG block, lumbar plexus block, hip dysplasia

Introduction: Developmental dysplasia of the hip is a congenital disorder of the hip joint, occurring in approximately 1 in 1,000 live births. Surgical management of congenital hip dysplasia is associated with moderate to severe pain, which is often treated with opioid analgesics that commonly lead to side effects. The most widely used analgesic technique for these surgeries is the ultrasound-guided lumbar plexus block. In 2018, the pericapsular nerve group (PENG) block was introduced as a new ultrasound-guided approach targeting the innervation of the hip joint through the femoral, obturator, and accessory obturator nerves, using a pericapsular needle insertion technique.

Objective: Evaluate the efficacy, safety, and duration of postoperative analgesia provided by the PENG block compared to the lumbar plexus block in pediatric patients undergoing hip surgery.

Methodology: Randomized, double-blind, controlled clinical trial. The population was pediatriac patients aged 3 to 13 years undergoing elective surgery for hip dysplasia. Following signed informed consent and child assent, patients were brought into the operating room, monitored (Type I monitoring), sedated, and given a subarachnoid block with Bupivacaine 0.3 mcg/kg. Group A: Ultrasound-guided lumbar plexus block. Group B: Ultrasound-guided PENG block. Both groups received Ropivacaine 0.2%, 0.5 ml/kg, with a maximum volume of 20 ml. Pain was assessed using the CHEOPS scale at the end of surgery, in the recovery room, and at 12, 24, and 48 hours postoperatively. The need for opioid rescue and adverse effects were documented. Statistical analysis included measures of central tendency, Chi-square test, and Student's t-test using SPSS software. A p-value < 0.05 was considered statistically significant.

Results: A total of 64 patients were included. The mean duration of analgesia was 17.13 hours in the PENG group versus 10.38 hours in the Lumbar Plexus group, with a statistically significant difference (p = 0.03). There were no statistically significant differences between the groups in CHEOPS pain scores at any time point, nor in the need for opioid rescue. Mean arterial pressure at the end of surgery was significantly lower in the Lumbar Plexus group.

Conclusions: The PENG block is a safe and effective alternative to the lumbar plexus block for postoperative pain management in pediatric patients undergoing hip surgery for developmental dysplasia of the hip. Further studies with larger patient populations are necessary to confirm these findings.