Pericapsular nerve group block (ultrasound-guided)

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

• femoral nerve block
• fascia iliaca block