TY - JOUR
T1 - “Diffusion of innovations”
T2 - a feasibility study on the pericapsular nerve group block in the emergency department for hip fractures
AU - Ramachandran, Anirudh
AU - Montenegro, Michelle
AU - Singh, Maninder
AU - Dixon, Trevor
AU - Kayani, Waqas
AU - Liang, Timothy
AU - Yu, Nick
AU - Reddy, Srinivas
AU - Liveris, Anna
AU - Manyapu, Mallika
AU - McEwan, Alyssia A.
AU - Nguyen, Vincent T.
AU - Sonenthal, Nechama V.
AU - Corbo, Jill
AU - Friedman, Benjamin W.
AU - Sperling, Jeremy
AU - Jones, Michael P.
AU - Halperin, Michael
N1 - Publisher Copyright:
© 2022 The Korean Society of Emergency Medicine.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Objective Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects. Through training, simulation, and supervision, we aim to determine whether it is feasible to perform the PENG block in the emergency department. Methods Phase 1 consisted of emergency physicians attending a workshop to demonstrate ultrasound proficiency, anatomical understanding, and procedural competency using a low-fidelity model. Phase 2 consisted of a prospective, observational, feasibility study of 10 patients with hip fractures. Pain scores, side effects, and opioid usage data were collected. Results The median pain score at time 0 (time of block) was 9 (interquartile range [IQR], 6.5–9). The median pain score at 30 minutes was 4 (IQR, 2.0–6.8) and 3.5 (IQR, 1.0–4.8) at 4 hours. All 10 patients required narcotics prior to the initiation of the PENG block with a median dosage of 6.25 morphine milligram equivalents (MME; IQR, 4.25–7.38 MME). After the PENG block, only 30% of the patients required further narcotics with a median dosage of 0 MME (IQR, 0–0.6 MME) until operative fixation. Conclusion In this feasibility study, PENG blocks were safely administered by trained emergency physicians under supervision. We demonstrated data suggesting a trend of pain relief and decreased opiate requirements, and further investigation is necessary to measure efficacy.
AB - Objective Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects. Through training, simulation, and supervision, we aim to determine whether it is feasible to perform the PENG block in the emergency department. Methods Phase 1 consisted of emergency physicians attending a workshop to demonstrate ultrasound proficiency, anatomical understanding, and procedural competency using a low-fidelity model. Phase 2 consisted of a prospective, observational, feasibility study of 10 patients with hip fractures. Pain scores, side effects, and opioid usage data were collected. Results The median pain score at time 0 (time of block) was 9 (interquartile range [IQR], 6.5–9). The median pain score at 30 minutes was 4 (IQR, 2.0–6.8) and 3.5 (IQR, 1.0–4.8) at 4 hours. All 10 patients required narcotics prior to the initiation of the PENG block with a median dosage of 6.25 morphine milligram equivalents (MME; IQR, 4.25–7.38 MME). After the PENG block, only 30% of the patients required further narcotics with a median dosage of 0 MME (IQR, 0–0.6 MME) until operative fixation. Conclusion In this feasibility study, PENG blocks were safely administered by trained emergency physicians under supervision. We demonstrated data suggesting a trend of pain relief and decreased opiate requirements, and further investigation is necessary to measure efficacy.
KW - Hip fractures
KW - Hospital emergency service
KW - Interventional ultrasonography
KW - Nerve block
KW - Pain management
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U2 - 10.15441/ceem.22.177
DO - 10.15441/ceem.22.177
M3 - Article
AN - SCOPUS:85139385460
SN - 2383-4625
VL - 9
SP - 198
EP - 206
JO - Clinical and Experimental Emergency Medicine
JF - Clinical and Experimental Emergency Medicine
IS - 3
ER -