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. 2023 Dec 8;58(6):e932-e938.
doi: 10.1055/s-0043-1776909. eCollection 2023 Dec.

Accuracy of Hip Pericapsular Nerve Block (PENG) without Ultrasound Aid in Patients with Hip Pain

Giancarlo Cavalli Polesello  1 , André Sanches Saú  2 , Marco Rudelli  3 , Walter Ricioli Junior  3 , Nayra Deise Dos Anjos Rabelo  4
Affiliations

Accuracy of Hip Pericapsular Nerve Block (PENG) without Ultrasound Aid in Patients with Hip Pain

Giancarlo Cavalli Polesello et al. Rev Bras Ortop (Sao Paulo). .

Abstract

Objective To describe and evaluate the accuracy of the pericapsular nerve group (PENG) block technique with no ultrasound guidance. Method Series of 40 infiltrations in patients with hip pain undergoing outpatient follow-up in the hip surgery group or admitted to the emergency room from a hospital in São Paulo, SP, Brazil. The hip PENG technique was guided by palpable anatomical pelvic structures, with no ultrasound orientation for needle positioning, using the equipment only to check the correct location after an unguided puncture. Results In the 40 hips infiltrated from 35 patients with a mean age of 59.2 years, the success rate was 85%. Among the mispositioned cases, 71.4% occurred in the first 13 applications and 28.6% in the subsequent 27 applications. In all patients, the neurovascular bundle was in the medial third of the pen-made demarcation. Even in cases with a failed needle location, the distance from the neurovascular bundle was safe. A single adverse effect occurred, with spontaneous improvement of the femoral nerve apraxia within two days. Conclusion Unguided PENG block is a viable technique for a physician knowledgeable about its application in services with no ultrasound availability.

Keywords: analgesia; anesthesia; hip fractures; nerve block; pain management.

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Conflict of interest statement

Conflito de Interesses Os autores declaram inexistência de Conflito de Interesses na realização deste trabalho.

Figures

Fig. 1
Fig. 1
Beginning of the skin demarcation. Drawing the anterior superior iliac spine (ASIS) contour and longitudinal and transverse palpation of the iliopubic branch.
Fig. 2
Fig. 2
Union of half of the anterior superior iliac spine (ASIS) and the apex of the pubic (P) demarcation.
Fig. 3
Fig. 3
Division of the demarcation in three parts.
Fig. 4
Fig. 4
Demarcation of half of the first third part.
Fig. 5
Fig. 5
Aspect of the needle angulation at 70° in the described demarcation.
Fig. 6
Fig. 6
Aspect of the needle towards the apex of the demarcated iliopubic branch and positioning of the ultrasound probe.
Fig. 7
Fig. 7
Ultrasonographic appearance of the structures with good positioning (A). Ultrasound appearance of the poor-positioned structures (B).
Fig. 1
Fig. 1
Início da demarcação da pele. Desenhado o contorno da espinha ilíaca antero superior (EIAS) e palpado o ramo iliopúbico longitudinalmente e transversalmente.
Fig. 2
Fig. 2
União da metade da EIAS e do vértice da demarcação púbica (P).
Fig. 3
Fig. 3
Demarcação da divisão em terços.
Fig. 4
Fig. 4
Demarcação da metade do primeiro terço.
Fig. 5
Fig. 5
Aspecto da angulação da agulha a 70° na demarcação descrita.
Fig. 6
Fig. 6
Aspecto da agulha em direção ao vértice do ramo iliopúbico demarcado e o posicionamento do transdutor ultrassonográfico.
Fig. 7
Fig. 7
Aspecto ultrassonográfico das estruturas visualizadas com bom posicionamento (A). Aspecto ultrassonográfico das estruturas visualizadas com mau posicionamento (B).
See this image and copyright information in PMC

References

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