Pericapsular nerve group block (ultrasound-guided)
Updates to Article Attributes
Pericapsular nerve group (PENG) blocks are one approach for delivering anesthesia to the hip joint. It is most commonly used in patients with fractures of the hip and bony pelvis 1.
Indications
- acetabular fractures 5
- pubic rami fractures
-
proximal femoral fractures
- intertrochanteric fractures
- subcapital fractures
Equipment
- curvilinear low-frequency ultrasound probe
- linear high-frequency probe may be considered
- disinfectant agent
- sterile ultrasound gel
- sterile probe cover
- local anesthetic
- skin or block needle
Procedure
The premise of utilizing this block is based upon the consistent anatomical location of the articular branches of the femoral nerve and accessory obturator nerves coursing between the iliopubic eminence of the superior pubic ramus and the anterior inferior iliac spine 2.
Sonographic landmarks which should be identified include:
- femoral artery
- femoral head
- femoral nerve
- ilium
- iliopubic eminence (IPE)
- anterior inferior iliac spine (AIIS)
- psoas tendon
Technique
The fascial plane between the ilium and psoas tendon is the target. Aligning the transducer roughly parallel to the course of the inguinal ligament, the psoas tendon is sought where it abuts the groove of bony ileum between the AIIS and IPE. A lateral to medial approach is used, ilium contacted lateral and deep to the psoas tendon, and the fascial plane hydro-dissected and opened in the usual manner, visualizing the elevation of the iliopsoas muscle from the underling superior pubic ramus 1.
See also
-<a title="Proximal femoral fractures" href="/articles/proximal-femoral-fractures">proximal femoral fractures</a><ul>- +<a href="/articles/proximal-femoral-fractures">proximal femoral fractures</a><ul>
-</ul><h4>Procedure</h4><h4> </h4><p>The premise of utilizing this block is based upon the consistent anatomical location of the articular branches of the <a title="Femoral nerve" href="/articles/femoral-nerve">femoral nerve</a> and <a title="accessory obturator nerve" href="/articles/accessory-obturator-nerve">accessory obturator</a> nerves coursing between the iliopubic eminence of the superior pubic ramus and the anterior inferior iliac spine <sup>2</sup>.</p><p>Sonographic landmarks which should be identified include:</p><ul>- +</ul><h4>Procedure</h4><p>The premise of utilizing this block is based upon the consistent anatomical location of the articular branches of the <a href="/articles/femoral-nerve">femoral nerve</a> and <a href="/articles/accessory-obturator-nerve">accessory obturator</a> nerves coursing between the iliopubic eminence of the superior pubic ramus and the anterior inferior iliac spine <sup>2</sup>.</p><p>Sonographic landmarks which should be identified include:</p><ul>
-</ul><h6>Technique</h6><p>The fascial plane between the ilium and psoas tendon is the target. Aligning the transducer roughly parallel to the course of the inguinal ligament, the psoas tendon is sought where it abuts the groove of bony ileum between the AIIS and IPE. A lateral to medial approach is used, ilium contacted lateral and deep to the psoas tendon, and the fascial plane hydro-dissected and opened in the usual manner, visualizing the elevation of the <a title="Iliopsoas muscle" href="/articles/iliopsoas-muscle">iliopsoas</a> muscle from the underling superior pubic ramus <sup>1</sup>. </p><h4>See also</h4><ul>-<li><a title="femoral nerve block" href="/articles/femoral-nerve-block">femoral nerve block</a></li>-<li><a title="fascia iliaca block" href="/articles/fascia-iliaca-block">fascia iliaca block</a></li>- +</ul><h6>Technique</h6><p>The fascial plane between the ilium and psoas tendon is the target. Aligning the transducer roughly parallel to the course of the inguinal ligament, the psoas tendon is sought where it abuts the groove of bony ileum between the AIIS and IPE. A lateral to medial approach is used, ilium contacted lateral and deep to the psoas tendon, and the fascial plane hydro-dissected and opened in the usual manner, visualizing the elevation of the <a href="/articles/iliopsoas-muscle">iliopsoas</a> muscle from the underling superior pubic ramus <sup>1</sup>. </p><h4>See also</h4><ul>
- +<li><a href="/articles/femoral-nerve-block">femoral nerve block</a></li>
- +<li><a href="/articles/fascia-iliaca-block">fascia iliaca block</a></li>
References changed:
- 1. Luftig J, Luftig DA, Luftig MD, Luftig HK, Luftig WA, Luftig NA, Luftig. A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block. (2020) The American journal of emergency medicine. <a href="https://doi.org/10.1016/j.ajem.2020.05.085">doi:10.1016/j.ajem.2020.05.085</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32532621">Pubmed</a> <span class="ref_v4"></span>
- 2.Short A, Short BJ, Short GM, Short BE, Short LK, Short AA, Short PP, Short. Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention. (2018) Regional anesthesia and pain medicine. <a href="https://doi.org/10.1097/AAP.0000000000000701">doi:10.1097/AAP.0000000000000701</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29140962">Pubmed</a> <span class="ref_v4"></span>
- 3. Ueshima H, Ueshima OH, Ueshima. Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. (2018) Journal of clinical anesthesia. <a href="https://doi.org/10.1016/j.jclinane.2018.08.003">doi:10.1016/j.jclinane.2018.08.003</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30096522">Pubmed</a> <span class="ref_v4"></span>
- 4. Lin D, Lin MC, Lin BB, Lin SA, Lin PR, Lin VM, Lin AS, Lin LT, Lin DJ, Lin KH, Lin JR, Lin. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. (2021) Regional anesthesia and pain medicine. <a href="https://doi.org/10.1136/rapm-2020-102315">doi:10.1136/rapm-2020-102315</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33637625">Pubmed</a> <span class="ref_v4"></span>
- 5. Bilal B, Bilal kzG, Bilal BF, Bilal TD, Bilal DaF, Bilal. High volume pericapsular nerve group (PENG) block for acetabular fracture surgery: A new horizon for novel block. (2020) Journal of clinical anesthesia. <a href="https://doi.org/10.1016/j.jclinane.2020.109702">doi:10.1016/j.jclinane.2020.109702</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31927234">Pubmed</a> <span class="ref_v4"></span>
Tags changed:
- pocus
- anesthesia
- neuroanatomy
- orthopaedics
- emergency
- ultrasound
Sections changed:
- Interventional Radiology