Discussion
obesity, fascia iliaca block, fracture, quadriceps weakness, pain, NRS
OBESITY, FRAGILITY, INFILTRATION, COMPLICATIONS
Herein we have demonstrated that application of a PENG block prior to spinal anesthesia in patients undergoing surgery for hip fracture not only reduces pain associated with spinal anesthesia positioning, but also increases practitioner satisfaction and decreases postoperative analgesic consumption compared to a control group. In addition, QoR 15 scores were found to be greater for patients that underwent PENG block.Current guidelines recommend fascia iliaca block or local anesthetic infiltration in hip fracture surgeries, where pain is highly expected [In a prospective mini-cohort investigating the effects of PENG block in patients undergoing hip surgery, PENG was applied to 20 consecutive patients undergoing hip surgery with satisfactory results reported with regard to spinal anesthesia positioning [In a study where the effect of PENG block in hip fracture surgery was compared to femoral block, the authors aimed to evaluate the postoperative analgesic effects and quadriceps weakness in both blocks [Our study is the first to investigate the effects of PENG block on both spinal anesthesia positioning and postoperative analgesic efficiency and QoR 15 score. Undoubtedly, additional comparative research on the use of PENG block in hip surgery is required.Although some publications hypothesize that lumbar plexus-like effects can be seen in PENG block when using 30 mL or more of LA, such an effect is not expected with 20 mL. As a result, it is obvious that PENG block will be insufficient for cutaneous anesthesia. Therefore, better results may be obtained with the combination of PENG block with other blocks in patients undergoing hip fracture surgery. A volunteer study on the cutaneous innervation of hip surgeries reported that subcostal nerve block and transversalis fascia plane block could be effective [The majority of patients undergoing surgery for hip fracture have a significant degree of fragility. This places patients at an elevated risk for LAST and compels clinicians to exercise greater caution. Volume and concentration of local anesthetic should be given careful consideration. In this investigation, we utilized 20 cc of local anesthetic for PENG block without experiencing any complications.Our study has some limitations. First of all, we did not assess quadriceps weakness in patients, which is crucial for early recovery. However, we did not observe any long-term consequences linked to quadriceps weakness. Secondly, we could have compared the efficacy of PENG block with a technique such as fascia iliaca block, which has previously been demonstrated to improve positioning in clinical studies. However such a design would mean we would have been unable to determine the long-term effects of PENG block by comparing it to a control group. Another limitation was that some patients in the control group had relatively high NRS scores, although all NRS scores were in the acceptable “bearable pain” category. Spinal anesthesia performance time is one of our outcomes, but it can also be affected by many factors of the patient such as anatomy, obesity, and other factors such as the experience of the practitioner.