Clinical outcomes of pericapsular nerve group block in hip arthroscopy: A systematic review and meta-analysis

In hip arthroscopy, regional anaesthesia techniques are gaining importance for pain management. A side effect of nerve blocks can be unintended motor block, affecting early post-operative mobilization. Pericapsular nerve group (PENG) block is a technique that may address this issue. This review compares the clinical effects of the PENG block with current pain management practices in hip arthroscopy.

A literature search was conducted in PubMed, Embase and the Cochrane Library, following the PRISMA guidelines. The primary outcome was post-operative pain. Secondary outcomes included duration of hospital stay, opioid use, post-operative motor function and complications. Outcomes were presented in subgroups categorized by study design (randomized controlled trials and retrospective comparative cohort studies). Risk of bias was assessed with both the Cochrane checklist and MINORS. Quality of evidence was evaluated using the Grades of Recommendation Assessment, Development and Evaluation.

This systematic review included four RCTs and six retrospective comparative cohort studies, comprising 900 patients in total. The RCTs reported lower mean pain scores at 24 h post-operatively and lower maximum pain scores at the post anaesthesia care unit (PACU) in the PENG group, with no differences observed in PACU time, opioid usage at the PACU or post-operative nausea and vomiting (PONV). The retrospective cohort studies revealed lower maximum and mean PACU pain scores, reduced PACU time, decreased opioid usage and a lower incidence of PONV in the PENG group. One RCT reported better quadriceps strength in PENG, whereas one RCT and cohort study reported no motor impairment in this group.

PENG block holds promise for post-operative pain relief, decreased opioid consumption, shorter PACU stay and potentially less PONV without affecting motor function. No differences in hospital stay or PACU opioid use were found, necessitating further research. Due to minimal risks and potential advantages, PENG could be a viable option for analgesia in hip arthroscopy.

Level III, review including Level I-III studies.