II. Background
- First described in 2018 for hip arthroplasty patients
III. Mechanism
- Interfascial plane block with Anesthesia to femoral nerve, obturator nerve, and accessory obturator nerve
-
Hip Joint articular branches (esp. accessory obturator) branches above the level of other common hip Nerve Blocks
- PENG Block includes these nerves
- PENG Block does not completely anesthetize the Hip Joint
- Posteromedial hip capsule is innervated by sciatic nerve which is not included in this block
IV. Indications
- Regional Anesthesia covering proximal femur (hip and anterior medial thigh) to knee
- Also provides Regional Anesthesia to medial lower leg and ankle
- Acetabular Fracture
- Femoral Neck Fracture (also covered by Fascia Iliaca Block)
- Mid-shaft Femur Fracture (also covered by Femoral Nerve Block)
V. Contraindications
- Coagulopathy (e.g. Warfarin, Rivaroxaban, Clopidogrel)
- Multi-system Trauma
- Compartment Syndrome
VI. Complications
VII. Technique
- Images
- Preparation
- Chlorhexidine or Povidone-Iodine Skin Preparation
- Patient in supine position
-
Ultrasound Probe
- Low frequency curvilinear transducer
- In-Plane Technique
- Transverse plane with Ultrasound probe parallel to the inguinal ligament
- Start in transverse plane over the femoral head and slide superiorly up to anterior inferior iliac spine (AIIS)
- May also slide medially along the inguinal crease from the ASIS to the AIIS
- Slide probe back inferiorly to visualize the psoas tendon (hyperechoic) overlying the public ramus
- Iliopubic emminence will sit inferior to the psoas tendon
- Identify femoral artery prior to injection
- Needle insertion
- Raise a small skin wheel of Local Anesthetic laterally over needle insertion site
- Avoid obscuring underlying structures (i.e. bubbles in Local Anesthetic) on Ultrasound
- Advance Nerve Block needle (e.g. 20 to 22 gauge, 100 mm) at 30-45 degrees transverse (in plane)
- Target inferior to the psoas tendon and superior to the public ramus
- Raise a small skin wheel of Local Anesthetic laterally over needle insertion site
-
Anesthetic
- Inject 20 ml Anesthetic (e.g. Ropivacaine 0.5%) into target region
- Hydrodissection should lift the the psoas tendon
VIII. References
- (2022) HQMedED Regional Anesthesia for Acute Care Providers, Minneapolis, MN, attended 6/3/2022
- Ben Aziz and Muhdomi (2022) Pericapsular Nerve Group Block, Stat Pearls, Treasure Island, accessed 6/4/2022
- Berlioz and Bojaxhi (2022) Pericapsular Nerve Group Block, Stat Pearls, Treasure Island, accessed 6/4/2022