Chemical hip denervation using phenol via Pericapsular Nerve Group (PENG) block in palliative non-operative management for frail older hip fracture patients: A multicenter retrospective cohort study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-27 DOI:10.1016/j.jclinane.2025.111872

Thamar Kroes MD , Hugo H. Wijnen MD , Koen Bos MD , Lennart G. Wasmoeth MD , Glenn van de Vossenberg MD , Bart Spaetgens MD PhD , Rachel J.H. Smits MD , Henk Jan Schuijt MD PhD , Hanna C. Willems MD PhD

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引用次数: 0

Abstract

Effective analgesia is critical yet challenging in non-operative management (NOM) of hip fractures for frail older patients in the palliative setting. Chemical hip denervation with phenol via PEricapsular Nerve Group (PENG) block has been applied to improve pain management. This is the first multicenter retrospective study that evaluated pain experience, opioid consumption and mobility in this population.

The study included 185 patients, aged 70 years or older, who received chemical hip denervation with phenol via PENG block in the context of NOM from January 2022 until August 2023 in six hospitals across the Netherlands. Patient data were extracted from electronic health records.

Patients were aged median 87 years (p25 - p75 82–91) with multiple comorbidities, the majority suffered from cognitive impairment (74 %) and depended on daily care (88 %). Phenol was mostly used with a concentration of 6 % (70 % of patients) or 10 % (23 % of patients) and a median volume of 10 ml (p25 - p75 8–10). Post procedural pain was experienced as acceptable in the majority of patients (89 % rest-related, 65 % care-related). The secondary outcomes of pain on a numeric rating scale (NRS) and morphine milligram equivalents (MME) were low. However, mobility remained limited. Median survival was 9 days (p25 - p75 4–22). Significant differences were observed in fracture type and hospital location. No complications or adverse treatment effects were reported.

Chemical hip denervation with phenol via PENG block may be a viable analgesic option in selected frail older hip fracture patients as part of person-centered, multidisciplinary palliative care. Study limitations included its retrospective design with unavailable data on quality of life. Future prospective studies should evaluate patient outcomes. Further research is necessary to define optimal techniques, phenol percentage and volumes and reduce practice variability.

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多中心回顾性队列研究：经囊包神经群（PENG）阻断苯酚化学髋关节去神经支配对老年体弱髋部骨折患者姑息性非手术治疗

有效的镇痛是关键的，但具有挑战性的非手术管理（NOM）的髋部骨折虚弱的老年患者姑息设置。苯酚经囊周神经群阻断（PENG）化学髋关节去神经支配已被应用于改善疼痛管理。这是第一项多中心回顾性研究，评估了该人群的疼痛体验、阿片类药物消费和活动能力。该研究包括185名年龄在70岁或以上的患者，他们在2022年1月至2023年8月期间在荷兰的6家医院接受了NOM背景下通过PENG阻滞的苯酚化学髋关节去神经控制。患者数据从电子健康记录中提取。患者中位年龄为87岁（p25 - p75 82-91），伴有多种合并症，大多数患有认知障碍（74%），依赖日常护理（88%）。苯酚的使用浓度大多为6%（70%的患者）或10%（23%的患者），中位体积为10 ml （p25 - p75 8-10）。大多数患者的术后疼痛是可以接受的（89%与休息有关，65%与护理有关）。疼痛的次要结果在数字评定量表（NRS）和吗啡毫克当量（MME）上较低。但是，流动性仍然有限。中位生存期为9天（p25 - p75 4-22）。在骨折类型和医院位置上有显著差异。无并发症及不良治疗反应。经PENG阻滞的苯酚化学髋关节去神经控制可能是一种可行的镇痛选择，作为以人为中心的多学科姑息治疗的一部分，选择虚弱的老年髋部骨折患者。研究的局限性包括其回顾性设计，无法获得生活质量数据。未来的前瞻性研究应评估患者的预后。进一步的研究需要确定最佳的技术，苯酚的百分比和体积，并减少实践的可变性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.