StatPearls-/-ä 2024[Jan]; ä (ä): ä PMID33620834show ga
Hip and knee surgery is a common orthopedic surgery among the elderly. In 2010 the prevalence of total hip replacement at fifty years of age was 0.58% and increased to 5.26% at eighty years in the United States (US). A recent US study projected that compared to 2010, annual use of primary knee and hip total joint arthroplasty would increase by 210% (655K to 1375K) and 174% (293K to 512K) in 2020, respectively. In 2015 the prevalence of total hip arthroplasty was estimated as more than 2.5 million individuals in the entire United States population. Osteoporosis and osteoarthritis contribute significantly to the surgical indication. There is a wide diversity in the patient population requiring hip surgery; children with congenital hip dysplasia, young athletic adults who undergo hip arthroscopy, and frail elderly patients with multiple medical problems who experience traumatic accidents following mechanical falls. 7 to 28% of operated patients develop chronic pain after a hip surgery. Regional anesthesia offers significant benefits in both pain control and recovery in patients undergoing total hip arthroplasties (THA). There is a wide range of regional anesthetic techniques. The most used in this anatomical area and the most supported by published literature are lumbar plexus block, femoral nerve block, and fascia iliaca block. Other techniques, such as selective obturator nerve infiltration and lateral femoral cutaneous nerve blocks, represent alternatives. New approaches have been described, such as quadratus lumborum block and local infiltration analgesia. However, these techniques require rigorous prospective studies. A recent anatomical study on hip innervation has made it possible to identify the relevant landmarks targeted on the hip joint branches from the femoral nerve and the accessory obturator nerve. A new regional anesthesia technique is thus discovered called pericapsular nerve group block (PENG), which targets the anterior capsule of the hip by blocking these nerves. The PENG block, first described by L Giron-Arango et al., is a novel regional analgesia technique to reduce pain after total hip arthroplasties (THA) while sparing motor function. This technique involves the deposition of the local anesthetic in the fascial plane between the psoas muscle and the superior pubic ramus. This is an interfascial plane block aiming to block articular branches supplied by femoral, obturator, and accessory obturator nerves, and is a promising regional anesthetic technique as an alternative to other regional nerve blocks such as femoral nerve block or an iliac fascia nerve block.
StatPearls-/-ä 2024 ; ä (ä): ä
