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. 2023 Aug 30;58(4):e646-e652.
doi: 10.1055/s-0042-1758367. eCollection 2023 Aug.

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study

Pedro Hamra  1 , André Sanches Sau  1 , Walter Ricioli Junior  2 , Nayra Deise Dos Anjos Rabelo  3 , Giancarlo Cavalli Polesello  2
Affiliations

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study

Pedro Hamra et al. Rev Bras Ortop (Sao Paulo). .

Abstract

Objective To evaluate the technical reproducibility of a block of the pericapsular nerve group (PENG) of the hip aided or not by ultrasound in cadavers. Materials and Methods The present is a randomized, descriptive, and comparative anatomical study on 40 hips from 2 cadaver groups. We compared the PENG block technique with the method with no ultrasound guidance. After injecting a methylene blue dye, we verified the dispersion and topographical staining of the anterior hip capsule through dissection. In addition, we evaluated the injection orifice in both techniques. Results In the comparative analysis of the techniques, there were no puncture failures, damage to noble structures in the orifice path, or differences in the results. Only 1 hip from each group (5%) presented inadequate dye dispersion within the anterior capsule, and in 95% of the cases submitted to either technique, there was adequate dye dispersion at the target region. Conclusion Hip PENG block with no ultrasound guidance is feasible, safe, effective, and highly reliable compared to its conventional counterpart. The present is a pioneer study that can help patients with hip pain from various causes in need of relief.

Keywords: analgesia; anesthesia; cadaver; hip joint; nerve block; peripheral nerve injuries.

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Conflict of interest statement

Conflito de Interesses Os autores não têm conflito de interesses a declarar.

Figures

Fig. 1
Fig. 1
Demarcated segment between the anterosuperior iliac spine (ASIS) and the pubic symphysis (PS).
Fig. 2
Fig. 2
Needle insertion at a 70° of inclination at the midpoint of the lateral third.
Fig. 3
Fig. 3
Probe positioning in the midpoint of the demarcated segment, with the PS at 45° of inclination.
Fig. 4
Fig. 4
Ultrasonographic image of the needle path (arrow). Abbreviations: ASIS, anteroinferior iliac spine; FA, femoral artery; FV, femoral vein; IPB, iliopubic branch; PT, iliopsoas muscle tendon.
Fig. 5
Fig. 5
Quadrangular skin flap for dissection.
Fig. 6
Fig. 6
Rectus femoris (RF) muscle retracted for better visualization of the methylene blue dispersion and anterior capsule staining..
Fig. 7
Fig. 7
Right hips from the group submitted to the technique with no ultrasound guidance, showing all capsules stained. Abbreviations: C1 to C10, cadavers 1 to 10.
Fig. 8
Fig. 8
Left hips from the group submitted to the technique with no ultrasound guidance, showing all capsules stained. Abbreviations: C1 to C10, cadavers 1 to 10.
Fig. 9
Fig. 9
Right hips from the group submitted to the technique with ultrasound guidance, showing no capsule staining. Abbreviations: C11 to C20, cadavers 11 to 20.
Fig. 10
Fig. 10
Left hips from the group submitted to the technique with ultrasound guidance, showing no capsule staining. Abbreviations: C11 to C20, cadavers 11 to 20.
Fig. 1
Fig. 1
Segmento demarcado entre a espinha ilíaca anterossuperior (EIAS) e a sínfise púbica (SP).
Fig. 2
Fig. 2
Inclinação de 70° para inserção da agulha no ponto médio do terço lateral.
Fig. 3
Fig. 3
Posicionamento da sonda no ponto médio do terço lateral do segmento demarcado e com inclinação de 45° da SP.
Fig. 4
Fig. 4
Imagem ultrassonográfica do trajeto da agulha, evidenciado pela seta. Abreviaturas: AF, artéria femoral; EIAI, espinha ilíaca anteroinferior; RIP, ramo iliopúbico; TP, tendão do músculo iliopsoas; VF, veia femoral.
Fig. 5
Fig. 5
Retalho de pele quadrangular para dissecção.
Fig. 6
Fig. 6
Músculo reto femoral (RF) rebatido para melhor visualização da dispersão do azul de metileno com coloração da cápsula anterior.
Fig. 7
Fig. 7
Quadris direitos do grupo submetido à técnica sem ultrassonografia, com todas as cápsulas coradas. Abreviaturas: C1 a C10, cadáveres 1 a 10.
Fig. 8
Fig. 8
Quadris esquerdos do grupo submetido à técnica sem ultrassonografia, com ausência de coloração da cápsula em C10. Abreviaturas: C1 a C10, cadáveres 1 a 10.
Fig. 9
Fig. 9
Quadris direitos do grupo submetido à técnica com ultrassonografia, com ausência de coloração da cápsula em C12. Abreviaturas: C11 a C20, cadáveres 11 a 20.
Fig. 10
Fig. 10
Quadris esquerdos do grupo submetido à técnica com ultrassonografia, com todas as cápsulas coradas. Abreviaturas: C11 a C20, cadáveres 11 a 20.
See this image and copyright information in PMC

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