TDNet Discover

Introduction: The management of postoperative pain in total hip arthroplasty (THA) is a persistent challenge, as poorly controlled pain can delay recovery, increase healthcare costs, and diminish patient satisfaction. Researchers propose pre-procedure pericapsular nerve group (PENG) blocks as an effective method for addressing these issues. By preemptively targeting nociceptive input from the hip joint, PENG blocks provide superior analgesia compared to systemic opioids or post-operative blocks. However, variability in practice among anesthesia providers, lack of standardization in block timing, and inconsistent education on peripheral nerve block (PNB) technique contribute to underutilization and uncertainty in its effectiveness. These challenges underscore the importance of examining the ability of pre-operative PENG blocks to deliver desired clinical outcomes reliably. Hence, this review aims to emphasize risks and benefits through provider education and address whether pre-procedure PENG peripheral nerve blocks improve patients' quality of pain, decrease length of stay in the recovery area, reduce the use of perioperative opioids and decrease postoperative nausea and vomiting (PONV) of the patient during the postoperative period. The underutilization of pre-operative PENG blocks has multifaceted implications. First, inadequate pain management following THA leads to increased opioid consumption, leading to a higher risk of opioid-related complications such as dependence, respiratory depression, and delayed recovery. The opioid epidemic further highlights the need for alternative, multimodal approaches to pain management, with PNBs emerging as a potential solution. Additionally, prolonged recovery times and increased postoperative complications, such as PONV, contribute to higher healthcare costs and reduced patient satisfaction. For providers, education on the risks and benefits of pre-procedure PENG blocks is critical in aligning clinical practices with enhanced recovery after surgery (ERAS) protocols. ERAS frameworks aim to reduce opioid use, 3 shorten hospital stays, and optimize patient outcomes. Addressing the knowledge gap surrounding the timing and efficacy of PENG blocks is essential to standardize care and promote better patient experiences. This literature review evaluates existing evidence on the use of pre-operative PENG blocks in THA patients to determine their effectiveness in improving postoperative pain management, reducing opioid consumption, shortening recovery area stays, and minimizing PONV. This review synthesizes data from recent studies to identify the risks and benefits of preoperative PENG block implementation, examine the impact of provider education on the adoption and efficacy of the technique, address knowledge gaps, and inform best practices for anesthesia providers. Ultimately, the findings aim to guide clinical decision-making, support standardization of care, and contribute to improved outcomes for THA patients. Disseminating this knowledge is essential to empowering anesthesia providers to adopt evidence-based practices that align with modern pain management strategies and improve overall patient outcomes.