Korean J Pain.  2023 Apr;36(2):195-207. 10.3344/kjp.22325.

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

• Kose SG
• Kose HC
• Celikel F
• Tulgar S
• Akkaya OT

• KMID: 2541028
• DOI: http://doi.org/10.3344/kjp.22325

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.

Keyword

Chronic Pain; Hip; Injections, Intra-Articular; Osteoarthritis, Hip; Pain Management; PENG Block; Quality of Life; Steroids; Ultrasonography, Interventional

Figure

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  Fig. 1 Study design and follow up. PENG: pericapsular nerve group, IAI: intra-articular injection, NRS: numerical rating scale, WOMAC: Western Ontario and McMaster University Osteoarthritis Index, HHS: Harris hip score, QAQ: quantitative analgesic questionnaire, CSI: central sensitization inventory.

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  Fig. 2 Examples of femoral head score and hip joint effusion. (A) Normal: round femoral head. (B) Mild: slightly flattened. (C) Moderate: very flattened. (D) Hip effusion (11 mm). White arrow indicates bone capsule distance.

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  Fig. 3 Scanning technique for pericapsular nerve group block. (A, B) The ultrasound probe was placed in a transverse plane over the ASIS, (C, D) then the probe was moved medio-caudally along the axis until the AIIS, (E, F) the probe was rotated to 45° parallel to the inguinal crease aligned with the pubic ramus to visualize the iliopubic eminence. White arrows indicate the needle trajectory. ASIS: anterior superior iliac spine, AIIS: anterior inferior iliac spine, FA: femoral artery, IPE: iliopubic eminence, PT: psoas tendon.

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  Fig. 4 (A) Transducer position, (B) sonographic image, and (C) schematic illustration showing the surrounding structures and needle position for pericapsular nerve group block. ASIS: anterior superior iliac spine, AIIS: anterior inferior iliac spine, IPE: iliopubic eminence, FA: femoral artery.

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  Fig. 5 Transducer placement (A) and sonoanatomy view (B) of hip-intrarticular injection. White arrows indicate the needle trajectory. Green dashed line indicates bone capsule distance. FN: femoral neck, FH: femoral head.

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  Fig. 6 Numerical rating scale (NRS) pain scores of patients. Values represent the means and standard deviations. PENG: pericapsular nerve group, IAI: intra-articular injection. *P < 0.05 vs. baseline. #P < 0.05 vs. between groups.

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