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. 2020 Aug;64(8):710-713.
doi: 10.4103/ija.IJA_388_20. Epub 2020 Jul 31.

Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique

Ashok Jadon  1 , Neelam Sinha  1 , Swastika Chakraborty  1 , Bhupendra Singh  1 , Amit Agrawal  1
Affiliations

Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique

Ashok Jadon et al. Indian J Anaesth. 2020 Aug.

Abstract

Background: Pericapsular nerve group (PENG) block is a new ultrasound guided nerve block. It was used primarily to relieve pain in hip fracture; now, many new indications have been added. However, dependency on ultrasound guidance for this block limits its use where ultrasound facility is poor or not available. We have suggested a landmark based technique to increase the benefit of this novel nerve block.

Aim and objectives: To do a feasibility study to assess the successful placement of block needle, clinical efficacy of the block and block-related complications.

Material and methods: Total 10 patients (4 males and 6 females) with fracture hip and scheduled for hip surgery under spinal anaesthesia were selected for the study. In 4 patients ultrasound guided PENG block using out-of-plane approach and in 6 patients landmark based nerve stimulator guided block was given with 20ml 0.25% bupivacaine and 8mg dexamethasone. Pain relief before and after 30 minutes of block was assessed by numeric rating scale (NRS) and comfort during spinal position was assessed by ease of spinal position score (EOSP).

Results: All 10 patients had successful block; NRS at rest was 6 (6-9) Vs 2 (0-2) and on 15 °limb elevation was 8 (8-10) Vs 3 (2-4). All patients could sit comfortably during spinal anaesthesia and median (range) EOSP sore was 3 (2-3). No complication was observed.

Conclusion: Landmark based technique for PENG block is a feasible option and can be used safely where ultrasound facility is not available.

Keywords: Fracture hip pain; landmark based nerve block; pericapsular nerve group block; spinal positioning; ultrasound guided nerve block.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Sonoanatomy view for PENG block, (b) Needle entry under ultrasound guided Out-of-plane (OOP) approach for PENG block, (c) Out-of-plane needle entry toward bony rim near IPE (d) spread of local anaesthetic below the illo-psoas muscle. ASIS-anterior superior iliac spine, AIIS-anterior inferior iliac spine, FA-femoral artery, IPE-iliopectineal eminence, IST-Ilio-psoas tendon
Figure 2
Figure 2
(a) Landmark-guided block; ASIS, PT, Femoral artery and skin entry point marked over skin. Blunt tip insulated needle attached with Nerve stimulator is entering after local infiltration of skin. (b) Needle entry point 5 cm medial to ASIS while two fingers are on femoral artery. ASIS-anterior superior iliac spine, FA-femoral artery
See this image and copyright information in PMC

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