Pericapsular Nerve Group Block to Improve Hip Arthroscopy Postoperative Pain
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Abstract
Problem: Hip arthroscopy patients at a metropolitan academic hospital experienced postoperative pain scores above the acceptable level of 4. Pain scores averaged 7.1, ranging from 5 to 9, indicating severe pain. Purpose: The purpose of this quality improvement (QI) project was to increase anesthesia providers’ utilization of regional anesthesia techniques among hip arthroscopy patients in the perioperative setting by implementing and measuring the use of pericapsular nerve group (PENG) blocks, an evidence-based practice change with potential to benefit over 100 patients yearly. Methods: Over 15 weeks, PENG block use was implemented for hip arthroscopy patients. The project lead (PL) collaborated with an interdisciplinary team, including the acute pain director (APD) and project clinical site representative (CSR), to plan and execute the following practice changes: create a PENG block protocol, post protocol in the 20 operating rooms (ORs), educate seven anesthesia providers (AP) in PENG block technique and protocol, and establish a workflow for administration of PENG block. AP administered the PENG block for hip arthroscopy patients, if not contraindicated. The PL tracked weekly progress via two surveys and an adherence audit tool with embedded pain assessment. Results: All seven APs the education survey. The OR protocol was 100% except for two weeks. The adherence of the PENG block was measured in ten of the fifteen weeks due to no hip arthroscopic procedures or no AP assigned. PENG block adherence had two weeks at 100%, one at 66.67%, and one at 50%. Conclusions: This QI achieved partial success; almost half of the ten weeks had adherence. A 20% PENG block adherence for AP resulted in six patients receiving the PENG block of the thirty eligible. Patients receiving PENG block averaged a 6.2 initial postoperative pain score. PENG remains a viable solution; however, a practice change will require more providers and a longer implementation.