A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework
<b>Introduction</b><b>:</b> With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow p...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-05-01
|
| Series: | Healthcare |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9032/10/6/1002 |
| _version_ | 1797486982796935168 |
|---|---|
| author | Tony Kwun-Tung Ng Jui-An Lin Sumire Sasaki |
| author_facet | Tony Kwun-Tung Ng Jui-An Lin Sumire Sasaki |
| author_sort | Tony Kwun-Tung Ng |
| collection | DOAJ |
| description | <b>Introduction</b><b>:</b> With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow patients to be discharged easily. While the conventional approach of ultrasound-guided anterior hip pericapsular neurolysis can help a lot of inoperable hip fracture patients to relieve their fracture pain and facilitate subsequent nursing care, enormous technical challenges are encountered in some cases. In this retrospective case study, we evaluated the overall pain and functional outcomes of our modified approach of anterior hip pericapsular neurolysis for inoperable hip fractures using the IDEAL framework. <b>Method</b>: This retrospective case series studied patients with acute inoperable hip fracture who received the modified approach of anterior hip pericapsular neurolysis from January 2018 to June 2019 according to the IDEAL recommendations. The modified approach consisted of pericapsular nerve group (PENG) injection, iliopsoas plane infiltration, and the sagittal approach of obturator nerve articular branches (ONAB) injection. Subsequent alcohol neurolysis would be performed in the same setting if there were positive diagnostic blocks. Assessments were carried out on post-intervention day 5. The primary outcome was pain intensity during hip flexion at 80 degrees in the recumbent position and during gentle hip internal and external rotation using an appropriate pain scoring tool. The secondary outcomes were the range of tolerable hip flexion and occurrence of any lower limb neurological deficit because of the procedure. Interim outcomes were also briefly evaluated. <b>Results</b>: Among the 74 patients who were reviewed in the study period, the median dynamic pain at hip flexion 80° (<i>p</i> < 0.001) and on gentle hip external and internal rotation (<i>p</i> < 0.001) was significantly reduced from a composite score of 3 (severe pain) to 1 (mild pain) on post-intervention day 5 after the modified approach of hip neurolysis. This translated to 72% of patients achieving satisfactory pain control, which was defined as a composite pain score of ≤1 on hip flexion at 80°. Functionally, the mean range of tolerable hip flexion significantly improved from 39.7° at baseline to 74° on post-intervention day 5 (<i>p</i> < 0.001). Transient and reversible hypotension was seen in about 10% of the patients. No other major procedural adverse event was noted. Interim follow-up at 4–6 months post-intervention revealed that more than 95% of patients continued to have satisfactory dynamic pain control (i.e., composite pain score ≤ 1). According to the IDEAL classification, this study could be ranked as stage 2a (development). <b>Conclusions</b>: Our findings suggested that anterior hip pericapsular neurolysis using a modified approach could offer consistent and satisfactory analgesic and functional benefits to a majority of patients with inoperable hip fractures during the interim of the fracture healing process, and it was potentially safer than the conventional approach. This technique might have achieved its readiness to proceed to the next stage of research according to the IDEAL framework. |
| first_indexed | 2024-03-09T23:42:07Z |
| format | Article |
| id | doaj.art-a1cb4c9a9d684bdf83010dc2161d8261 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-09T23:42:07Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-a1cb4c9a9d684bdf83010dc2161d82612023-11-23T16:51:22ZengMDPI AGHealthcare2227-90322022-05-01106100210.3390/healthcare10061002A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL FrameworkTony Kwun-Tung Ng0Jui-An Lin1Sumire Sasaki2Pain Management Unit, Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong, ChinaCenter for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, TaiwanDepartment of Anaesthesia and Operating Theatre Services, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Hong Kong, China<b>Introduction</b><b>:</b> With an increasingly ageing population, there is a growing impact of fragility hip fracture on the healthcare system and on society as a whole. Oral and injectable analgesics are often insufficient whilst traction and regional blocks do not allow patients to be discharged easily. While the conventional approach of ultrasound-guided anterior hip pericapsular neurolysis can help a lot of inoperable hip fracture patients to relieve their fracture pain and facilitate subsequent nursing care, enormous technical challenges are encountered in some cases. In this retrospective case study, we evaluated the overall pain and functional outcomes of our modified approach of anterior hip pericapsular neurolysis for inoperable hip fractures using the IDEAL framework. <b>Method</b>: This retrospective case series studied patients with acute inoperable hip fracture who received the modified approach of anterior hip pericapsular neurolysis from January 2018 to June 2019 according to the IDEAL recommendations. The modified approach consisted of pericapsular nerve group (PENG) injection, iliopsoas plane infiltration, and the sagittal approach of obturator nerve articular branches (ONAB) injection. Subsequent alcohol neurolysis would be performed in the same setting if there were positive diagnostic blocks. Assessments were carried out on post-intervention day 5. The primary outcome was pain intensity during hip flexion at 80 degrees in the recumbent position and during gentle hip internal and external rotation using an appropriate pain scoring tool. The secondary outcomes were the range of tolerable hip flexion and occurrence of any lower limb neurological deficit because of the procedure. Interim outcomes were also briefly evaluated. <b>Results</b>: Among the 74 patients who were reviewed in the study period, the median dynamic pain at hip flexion 80° (<i>p</i> < 0.001) and on gentle hip external and internal rotation (<i>p</i> < 0.001) was significantly reduced from a composite score of 3 (severe pain) to 1 (mild pain) on post-intervention day 5 after the modified approach of hip neurolysis. This translated to 72% of patients achieving satisfactory pain control, which was defined as a composite pain score of ≤1 on hip flexion at 80°. Functionally, the mean range of tolerable hip flexion significantly improved from 39.7° at baseline to 74° on post-intervention day 5 (<i>p</i> < 0.001). Transient and reversible hypotension was seen in about 10% of the patients. No other major procedural adverse event was noted. Interim follow-up at 4–6 months post-intervention revealed that more than 95% of patients continued to have satisfactory dynamic pain control (i.e., composite pain score ≤ 1). According to the IDEAL classification, this study could be ranked as stage 2a (development). <b>Conclusions</b>: Our findings suggested that anterior hip pericapsular neurolysis using a modified approach could offer consistent and satisfactory analgesic and functional benefits to a majority of patients with inoperable hip fractures during the interim of the fracture healing process, and it was potentially safer than the conventional approach. This technique might have achieved its readiness to proceed to the next stage of research according to the IDEAL framework.https://www.mdpi.com/2227-9032/10/6/1002hip fractureship jointneurolysispain managementIDEAL classification |
| spellingShingle | Tony Kwun-Tung Ng Jui-An Lin Sumire Sasaki A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework Healthcare hip fractures hip joint neurolysis pain management IDEAL classification |
| title | A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework |
| title_full | A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework |
| title_fullStr | A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework |
| title_full_unstemmed | A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework |
| title_short | A Preliminary Analysis of a Modified Anterior Approach to Hip Pericapsular Neurolysis for Inoperable Hip Fracture Using the IDEAL Framework |
| title_sort | preliminary analysis of a modified anterior approach to hip pericapsular neurolysis for inoperable hip fracture using the ideal framework |
| topic | hip fractures hip joint neurolysis pain management IDEAL classification |
| url | https://www.mdpi.com/2227-9032/10/6/1002 |
| work_keys_str_mv | AT tonykwuntungng apreliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework AT juianlin apreliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework AT sumiresasaki apreliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework AT tonykwuntungng preliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework AT juianlin preliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework AT sumiresasaki preliminaryanalysisofamodifiedanteriorapproachtohippericapsularneurolysisforinoperablehipfractureusingtheidealframework |