Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Nov 2023
Randomized Controlled TrialPericapsular nerve group (PENG) block for early pain management of elderly patients with hip fracture: a single-center double-blind randomized controlled trial.
The pericapsular nerve group block (PENG) is a novel technique that blocks the articular branches of the hip joint. This study aimed to compare its effectiveness to a sham block in elderly patients with hip fractures. ⋯ PENG block provided effective analgesia for acute traumatic pain following hip fracture. Further studies are required to validate the superiority of PENG blocks over other regional techniques.
-
Reg Anesth Pain Med · Oct 2023
Randomized Controlled TrialRandomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty.
This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). ⋯ For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration.
-
Reg Anesth Pain Med · Sep 2023
Randomized Controlled Trial Multicenter StudyPatient-centered results from a multicenter study of continuous peripheral nerve blocks and postamputation phantom and residual limb pain: secondary outcomes from a randomized, clinical trial.
We previously reported that a 6-day continuous peripheral nerve block reduces established postamputation phantom pain. To provide patients and providers with the information to best inform treatment decisions, here we reanalyze the data and present the results in a more patient-centered format. We also provide information on patient-defined clinically relevant benefits to facilitate evaluation of available studies and guide future trial design. ⋯ Among patients with postamputation phantom pain, a continuous peripheral nerve block more than doubles the chance of a clinically relevant improvement in pain intensity. Amputees with phantom and/or residual limb pain rate analgesic improvements as clinically relevant similarly to other chronic pain etiologies, although their smallest relevant improvement in the Brief Pain Inventory was significantly larger than previously published values.
-
Reg Anesth Pain Med · Sep 2023
Case Reports Randomized Controlled TrialContinuous erector spinae plane catheters leading to unwanted neuraxial spread after spinal fusion surgery: a report of two cases from a terminated prospective randomized clinical trial.
Erector spinae plane blocks are used to improve outcomes after spine surgery, but pain frequently outlasts the duration of single injection blocks. We hypothesized continuous erector spinae plane (cESP) catheters would provide superior analgesia. We terminated a prospective double-blinded randomized clinical trial (RCT) comparing outcomes after multilevel spine surgery among patients randomized to saline versus ropivacaine cESP catheters. We present two cases of undesired epidural spread of ropivacaine and discuss etiology, management, and future research directions. ⋯ Unwanted neuraxial spread of local anesthetic from cESP catheters may be a unique consideration after spine surgery, accounted for by unpredictable local anesthetic distribution within disrupted surgical planes. Future studies are indicated to determine optimal catheter regimens together with guidance for extended monitoring in parallel with further studies of efficacy in spine surgery cohorts.