The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Ultrasound-guided PENG block versus intraarticular corticosteroid injection in hip osteoarthritis: a randomised controlled study

  • Selin Guven Kose (Department of Pain Medicine, Health Science University Gaziler Physical Therapy and Rehabilitation Training and Research Hospital) ;
  • Halil Cihan Kose (Department of Pain Medicine, Health Science University Diskapi Yildirim Beyazit Training and Research Hospital) ;
  • Feyza Celikel (Department of Physical Therapy and Rehabilitation, Sakarya Training and Research Hospital) ;
  • Serkan Tulgar (Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital) ;
  • Omer Taylan Akkaya (Department of Pain Medicine, Health Science University Diskapi Yildirim Beyazit Training and Research Hospital)
  • Received : 2022.09.28
  • Accepted : 2022.12.13
  • Published : 2023.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study aimed to compare the effectiveness of the pericapsular nerve group (PENG) block and intra-articular injection (IAI) of steroid-bupivacaine in the treatment of hip osteoarthritis (OA). Methods: After randomization, patients received either a PENG block or IAI under ultrasound-guidance. Clinical evaluations were recorded at baseline, day 1, and weeks 1, 4, and 8 post-intervention. The numerical rating scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Scale (HHS) scores, pain medication use determined by a quantitative analgesic questionnaire, and patient satisfaction were evaluated. Results: Sixty patients were included in this study. NRS scores improved significantly for both groups during the follow-up compared to pretreatment (P < 0.001), with better pain scores for the PENG group (P < 0.001) at day 1 with larger effect size (Cohen's d = 4.62), and IAI group at 4 (Cohen's d = 5.15) and 8 (Cohen's d = 4.33) weeks (P < 0.001). There was no significant difference in pain medication consumption (P = 0.499) and patient satisfaction (P = 0.138) between groups. Patients in the IAI group experienced significant improvement in HHS (Cohen's d = 2.16, P = 0.007) and WOMAC (Cohen's d = 1.02, P = 0.036) scores at 8 weeks compared to the PENG group. Conclusions: The ultrasound-guided PENG block provides effective pain relief which improves functionality and quality of life in hip OA patients up to 2 months. The PENG block can be considered an easy, safe, and useful alternative treatment modality for hip OA.

Keywords

References

  1. Brandt KD, Radin EL, Dieppe PA, van de Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Ann Rheum Dis 2006; 65: 1261-4. https://doi.org/10.1136/ard.2006.058347
  2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545-602. Erratum in: Lancet 2017; 389: e1.
  3. Murphy LB, Helmick CG, Schwartz TA, Renner JB, Tudor G, Koch GG, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage 2010; 18: 1372-9. https://doi.org/10.1016/j.joca.2010.08.005
  4. Hiligsmann M, Cooper C, Arden N, Boers M, Branco JC, Luisa Brandi M, et al. Health economics in the field of osteoarthritis: an expert's consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2013; 43: 303-13. https://doi.org/10.1016/j.semarthrit.2013.07.003
  5. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum 2014; 43: 701-12.
  6. Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis Cartilage 2012; 20: 1095-102. https://doi.org/10.1016/j.joca.2012.05.015
  7. Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement. Reg Anesth Pain Med 2012; 37: 415-22. https://doi.org/10.1097/AAP.0b013e318251b688
  8. Choueiri M, Chevalier X, Eymard F. Intraarticular corticosteroids for hip osteoarthritis: a review. Cartilage 2021; 13(1_suppl): 122S-31S. https://doi.org/10.1177/1947603520951634
  9. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27: 1578-89. https://doi.org/10.1016/j.joca.2019.06.011
  10. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2020; 72: 149-62. Erratum in: Arthritis Care Res (Hoboken) 2021; 73: 764.
  11. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology 2019; 293: 656-63. https://doi.org/10.1148/radiol.2019190341
  12. Ming LH, Chin CS, Yang CT, Suhaimi A. Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study. Korean J Pain 2022; 35: 191-201. https://doi.org/10.3344/kjp.2022.35.2.191
  13. Ghai B, Kumar M, Makkar JK, Goni V. Comparison of ultrasound guided pulsed radiofrequency of genicular nerve with local anesthetic and steroid block for management of osteoarthritis knee pain. Korean J Pain 2022; 35: 183-90. https://doi.org/10.3344/kjp.2022.35.2.183
  14. Yavuz F, Yasar E, Ali Taskaynatan M, Goktepe AS, Tan AK. Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain. J Back Musculoskelet Rehabil 2013; 26: 79-83. https://doi.org/10.3233/BMR-2012-00353
  15. Giron-Arango L, Peng PW, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med 2018; 43: 859-63. https://doi.org/10.1097/AAP.0000000000000847
  16. Rocha Romero A, Carvajal Valdy G, Lemus AJ. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anaesth 2019; 66: 1270-1. https://doi.org/10.1007/s12630-019-01448-y
  17. Pimenta MV, Nakamura AT, Ashmawi HA, Vieira JE, Dos San H. Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report. Braz J Anesthesiol 2021. doi: 10.1016/j.bjane.2021.02.037
  18. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991; 34: 505-14. https://doi.org/10.1002/art.1780340502
  19. Koski JM, Anttila PJ, Isomaki HA. Ultrasonography of the adult hip joint. Scand J Rheumatol 1989; 18: 113-7. https://doi.org/10.3109/03009748909099926
  20. Qvistgaard E, Torp-Pedersen S, Christensen R, Bliddal H. Reproducibility and inter-reader agreement of a scoring system for ultrasound evaluation of hip osteoarthritis. Ann Rheum Dis 2006; 65: 1613-9. https://doi.org/10.1136/ard.2005.050690
  21. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833-40.
  22. Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty 2001; 16: 575-80. https://doi.org/10.1054/arth.2001.23716
  23. Robinson-Papp J, George MC, Wongmek A, Nmashie A, Merlin JS, Ali Y, et al. The quantitative analgesic questionnaire: a tool to capture patient-reported chronic pain medication use. J Pain Symptom Manage 2015; 50: 381-6. https://doi.org/10.1016/j.jpainsymman.2015.03.013
  24. Neblett R, Cohen H, Choi Y, Hartzell MM, Williams M, Mayer TG, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013; 14: 438-45. https://doi.org/10.1016/j.jpain.2012.11.012
  25. 5-point Likert scale. In: Handbook of disease burdens and quality of life measures. Edited by Preedy VR, Watson RR. Springer. 2010, p 4288.
  26. Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis 2011; 70: 110-6. https://doi.org/10.1136/ard.2009.127183
  27. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019; 393: 1745-59. https://doi.org/10.1016/S0140-6736(19)30417-9
  28. Healy WL, Iorio R, Clair AJ, Pellegrini VD, Della Valle CJ, Berend KR. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by The Hip Society. Clin Orthop Relat Res 2016; 474: 357-64. https://doi.org/10.1007/s11999-015-4341-7
  29. Hwang SK. Experience of complications of hip arthroplasty. Hip Pelvis 2014; 26: 207-13. https://doi.org/10.5371/hp.2014.26.4.207
  30. Gundel O, Thygesen LC, Gogenur I, Ekeloef S. Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study. Acta Orthop 2020; 91: 58-62. https://doi.org/10.1080/17453674.2019.1680485
  31. Yanagidate F, Strichartz GR. Local anesthetics. Handb Exp Pharmacol 2007; (177): 95-127.
  32. Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am 2006; 88: 1361-72. https://doi.org/10.2106/JBJS.D.03018
  33. Conrozier T, Patarin J, Mathieu P, Rinaudo M. Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications. Springerplus 2016; 5: 170.
  34. Yamak Altinpulluk E, Galluccio F, Salazar C, Espinoza K, Olea MS, Hochberg U, et al. Peng block in prosthetic hip replacement: a cadaveric radiological evaluation. J Clin Anesth 2020; 65: 109888.
  35. Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Reg Anesth Pain Med 2019; 44: 257.
  36. Jadon A. Pulsed radiofrequency (PRF) of pericapsular nerves group (PENG) in chronic hip pain-a case report. Turk J Anaesthesiol Reanim 2021; 49: 490-3. https://doi.org/10.5152/TJAR.2021.1080
  37. Fusco P, Petroni GM, DI Carlo S, Maggiani C, Marinangeli F, Ciaschi W. PENG radiofrequency and hip chronic pain: is this the future? Minerva Anestesiol 2021; 87: 1391-3. https://doi.org/10.23736/S0375-9393.21.15929-2
  38. McCabe PS, Maricar N, Parkes MJ, Felson DT, O'Neill TW. The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2016; 24: 1509-17. https://doi.org/10.1016/j.joca.2016.04.018
  39. Zhong HM, Zhao GF, Lin T, Zhang XX, Li XY, Lin JF, et al. Intra-articular steroid injection for patients with hip osteoarthritis: a systematic review and meta-analysis. Biomed Res Int 2020; 2020: 6320154.
  40. Peters RH, Rasker JJ, Jacobs JW, Prevo RL, Karthaus RP. Bacterial arthritis in a district hospital. Clin Rheumatol 1992; 11: 351-5. https://doi.org/10.1007/BF02207192
  41. Kaandorp CJ, van Schaardenburg D, Krijnen P. [Antibiotic prophylaxis of hematogenous bacterial arthritis]. Ned Tijdschr Geneeskd 1999; 143: 1808-11. Dutch.
  42. Papavasiliou AV, Isaac DL, Marimuthu R, Skyrme A, Armitage A. Infection in knee replacements after previous injection of intra-articular steroid. J Bone Joint Surg Br 2006; 88: 321-3. https://doi.org/10.1302/0301-620X.88B3.17136
  43. Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA. Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty? J Arthroplasty 2015; 30: 1879-82. https://doi.org/10.1016/j.arth.2015.05.027
  44. Sreekumar R, Venkiteswaran R, Raut V. Infection in primary hip arthroplasty after previous steroid infiltration. Int Orthop 2007; 31: 125-8. https://doi.org/10.1007/s00264-006-0152-5
  45. Desai A, Ramankutty S, Board T, Raut V. Does intraarticular steroid infiltration increase the rate of infection in subsequent total knee replacements? Knee 2009; 16: 262-4. https://doi.org/10.1016/j.knee.2008.12.002
  46. Del Buono R, Padua E, Pascarella G, Costa F, Tognu A, Terranova G, et al. Pericapsular nerve group block: an overview. Minerva Anestesiol 2021; 87: 458-66. https://doi.org/10.23736/S0375-9393.20.14798-9
  47. Alakkad H, Naeeni A, Chan VW, Abbas S, Oh J, Ami N, et al. Infection related to ultrasound-guided single-injection peripheral nerve blockade: a decade of experience at toronto Western hospital. Reg Anesth Pain Med 2015; 40: 82-4. https://doi.org/10.1097/AAP.0000000000000181
  48. Park KD, Kim TK, Bae BW, Ahn J, Lee WY, Park Y. Ultrasound guided intra-articular ketorolac versus corticosteroid injection in osteoarthritis of the hip: a retrospective comparative study. Skeletal Radiol 2015; 44: 1333-40. https://doi.org/10.1007/s00256-015-2174-9
  49. Ladd LM, Keene JS, Del Rio AM, Rosas HG. Correlation between hip arthroscopy outcomes and preoperative anesthetic hip joint injections, MR arthrogram imaging findings, and patient demographic characteristics. AJR Am J Roentgenol 2016; 207: 1062-9. https://doi.org/10.2214/AJR.16.16383
  50. Alpaugh K, Logan C, Upadhyaya S, Martin SD. Intraarticular anesthetic injection of the hip for confirmation of symptomatic tears of the acetabular labrum: a systematic review. Orthop J Harv Med Sch 2016; 17: 30-8.