Posterior hip pericapsular neurolysis (PHPN) for inoperable hip fracture: an adjunct to anterior hip pericapsular neurolysis.

BACKGROUND: The development of anterior hip neurolysis has made an appreciable impact on the management of patients with inoperable hip fracture. Nonetheless, suboptimal analgesic benefit was still observed in some patients. We therefore developed a novel posterior hip pericapsular neurolysis (PHPN) to complement anterior hip neurolysis in inoperable hip fracture.
METHODS: In this retrospective review, we analyzed patients who responded suboptimally (defined as composite pain score moderate or higher on hip flexion 80°) to the anterior hip neurolysis from July 2019 to March 2021. The patients received additional PHPN if the composite pain score was suboptimal. The percentage of patients with dynamic composite pain scores on hip flexion to 80° and on gentle hip external and internal rotation on post-intervention day 5 was then evaluated.
RESULTS: Among the 70 patients who were reviewed in the study period, 20 patients who partially responded to anterior hip neurolysis received an addition of diagnostic posterior hip pericapsular block. Eighteen patients were the positive responders and PHPN was then performed. Among the PHPN recipients, a high percentage with satisfactory dynamic pain control was observed with 78% on hip flexion 80° and 83% on hip external/internal rotation on day 5 following the intervention. No procedural adverse event was noted.
CONCLUSIONS: While most patients responded satisfactorily to anterior hip neurolysis, we concluded PHPN could be an effective adjunct to manage suboptimal pain control after anterior hip neurolysis in inoperable hip fracture. TRIAL REGISTRATION NUMBER: NTWC/REC/21061. © American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.