Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Mar 11, 2024; 13(1): 90514
Published online Mar 11, 2024. doi: 10.5313/wja.v13.i1.90514
Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement
Somita Christopher, Sweety Dutta, Thota Venkata Sanjeev Gopal
Somita Christopher, Sweety Dutta, Thota Venkata Sanjeev Gopal, Department of Anaesthesiology, Care Hospitals, Hyderabad 500025, India
Author contributions: Christopher S and Dutta S designed and performed the research; Christopher S, Dutta S and Gopal TVS analysed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Institutional Ethics Committee Care Hospital, No. IEC/CARE/22048/2023/PB.
Informed consent statement: All study participants or their legal guardian provided written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict-of-interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at somitachristopher@gmail.com. Participants gave informed consent for data sharing. No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Somita Christopher, MD, Doctor, Department of Anaesthesiology, Care Hospitals, Flat No. 504 B, Amsri Central Court, Near Lancer Lines, Hyderabad 500025, India. somitachristopher@gmail.com
Received: December 9, 2023
Peer-review started: December 9, 2023
First decision: December 23, 2023
Revised: January 5, 2024
Accepted: February 25, 2024
Article in press: February 25, 2024
Published online: March 11, 2024
Processing time: 89 Days and 18.1 Hours
Abstract
BACKGROUND

Osteonecrosis or avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients. Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous (IV) or oral dexamethasone, methylprednisolone or hydrocortisone. The use of such high doses of corticosteroids has shown very positive results and has been lifesaving in many cases. Still, long-term consequences were drug-induced diabetes, osteoporosis, Cushing syndrome, muscle wasting, peripheral fat mobilization, AVN, hirsutism, sleep disturbances and poor wound healing. A significant number of young patients were admitted for bilateral total hip replacements (THR) secondary to AVN following steroid use for COVID-19 treatment.

AIM

To assess the efficacy of bilateral pericapsular end nerve group (PENG) blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.

METHODS

This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals, Hyderabad, India. Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months. All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.

RESULTS

The duration of surgery was 2.5 h on average. Seventeen out of twenty patients (85%) had a Visual Analog Score (VAS) of less than 2 and did not require any supplementation. One patient was removed from the study, as he required re-exploration. The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug. Fifteen out of seventeen patients (88.2%) could be mobilized 12 h after the procedure.

CONCLUSION

Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19, which surfaced in patients who received steroid therapy requiring surgical intervention. Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.

Keywords: Avascular necrosis; Pericapsular end nerve group block; Analgesia; Hip replacement; COVID-19; Steroids

Core Tip: Avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the COVID-19 treatment protocol. High doses of corticosteroids have shown positive results and have been lifesaving in many cases. Still, long-term consequences were AVN of the hip, which unfortunately affected young individuals. These patients were posted for bilateral hip replacement surgeries. Our study aimed to study the dynamics of pericapsular end nerve block to provide adequate analgesia to these patients for enhanced postoperative recovery and discharge. While epidural analgesia is the gold standard technique, it has several complications like hypotension, motor blockade and urinary retention.