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Effect of Pericapsular Nerve Group Block with Different Concentrations and Volumes of Ropivacaine on Functional Recovery in Total Hip Arthroplasty: A Randomized, Observer-Masked, Controlled Trial [Response to Letter]
Received 12 July 2024
Accepted for publication 25 July 2024
Published 12 August 2024 Volume 2024:17 Pages 2639—2640
Ying Huang, Chun-Shan Dong
Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital, Hefei, Anhui, People’s Republic of China
Correspondence: Chun-Shan Dong, Department of Anesthesiology, Third Affiliated Hospital of Anhui Medical University, Hefei Huaihe Road No. 390, Hefei, Anhui, 230061, People’s Republic of China, Tel +86-13023030292, Email [email protected]
View the original paper by Mrs Huang and colleagues
This is in response to the Letter to the Editor
Dear editor
We thank Dr Wang et al1 for their interest in our study.2 They expressed some concerns regarding the methodological issues, proposing to conclude the result using more scientific and objective methods.
Firstly, we agree with that issues of surgical access and surgical etiology are factors that may affect the accuracy of hip muscle status. Total hip arthroplasty (THA) is a widely used method for treating hip fractures and femoral head necrosis.2 In our study, there was no statistically significant difference in the number of patients with femoral head necrosis and fracture among the three groups. In addition, surgical methods used in our study among the three groups were both lateral incisions, but they were not clearly described in the method, which is a limitation of our study. We will further improve it in the future.
Secondly, we assess sensory blockages and postoperative quadriceps motor block based on the methods of previous literature.3–5 We do not deny that electromyography or other electrophysiological examination techniques are more objective for verification. If conditions permit, we will further verify in the future.
Thirdly, our randomized comparative trial shows that PENG block with 20 mL 0.5%, 20 mL 0.25%, and 10 mL 0.5% ropivacaine provides equally effective pain control. This is slightly different from the conclusion drawn by Wen et al6 that the postoperative analgesic effect of the 20mL and 30mL groups of 0.33% ropivacaine is better than that of the 10mL group of 0.33% ropivacaine. Possible reasons are as follows: Group C in our study used 10mL of high concentration 0.5% ropivacaine. High concentration ropivacaine will provide more comprehensive analgesia.7 Besides, for THA, guidelines8 recommend the multimodal analgesia. Postoperatively, all patients in three groups in our study received the same multimodal analgesia.
In conclusion, although we have preliminarily concluded that a higher incidence of motor blockade of PENG block was mainly caused by excessive volume, we share the concerns of Dr Wang et al regarding a methodological issues. As Dr Wang et al mentioned, we hope that future studies will confirm our findings using electromyography or other electrophysiological examination techniques to verify quadriceps muscle strength, and MRI or 3D-CT strategies to better visualize the diffusion of local anaesthetics administered.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Wang X, Ma H. Effect of pericapsular nerve group block with different concentrations and volumes of ropivacaine on functional recovery in total hip arthroplasty: a randomized, observer-masked, controlled trial [Letter]. J Pain Res. 2024;17:2345–2346. doi:10.2147/JPR.S481146
2. Huang Y, Lu Y, Wang J, et al. Effect of pericapsular nerve group block with different concentrations and volumes of ropivacaine on functional recovery in total hip arthroplasty: a randomized, observer-masked, controlled trial. J Pain Res. 2024;17:677–685. doi:10.2147/JPR.S445000
3. Bravo D, Layera S, Aliste J, et al. Lumbar plexus block versus suprainguinal fascia iliaca block for total Hip arthroplasty: a single-blinded, randomized trial. J Clin Anesth. 2020;66:109907. doi:10.1016/j.jclinane.2020.109907
4. Aliste J, Layera S, Bravo D, et al. Randomized comparison between pericapsular nerve group (PENG) block and suprainguinal fascia iliaca block for total Hip arthroplasty. Reg Anesth Pain Med. 2021;46(10):874–878. doi:10.1136/rapm-2021-102997
5. Pascarella G, Costa F, Del Buono R, et al. Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total Hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia. 2021;76(11):1492–1498. doi:10.1111/anae.15536
6. Wen H, Zhang W, Wang Y, Lu M. Effects of different volumes of ropivacaine for pericapsular nerve group on incidence of quadriceps weakness and analgesic efficacy following hip arthroplasty: a randomized controlled trial. Pain Ther. 2024;13(3):533–541. doi:10.1007/s40122-024-00590-w
7. Huang L, Zheng L, Wu B, et al. Effects of ropivacaine concentration on analgesia after ultrasound-guided serratus anterior plane block: a randomized double-blind trial. J Pain Res. 2020;13:57–64. doi:10.2147/JPR.S229523
8. Anger M, Valovska T, Beloeil H, et al. PROSPECT guideline for total Hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(8):1082–1097. doi:10.1111/anae.15498
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