Comment on: Total hip arthroplasty under continuous pericapsular nerve group block (cPENG) in a high-risk patient

Bhakta, Pradipta; Karim, Habib Md Reazaul; O’Donnell, Brian D.

doi:10.1016/j.jclinane.2021.110301

Cited by 1 publication

(2 citation statements)

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“…However, possibilities of technical failure, such as structural misinterpretation during block performance, should also be considered in these low-quality PENG block studies. For example, as pointed out recently by a correspondence letter [ 73 ], a case report claiming to have achieved surgical anesthesia for total hip arthroplasty with just a 15 mL PENG block combined with propofol infusion had actually performed a bona fide intramuscular injection (with the needle tip placed directly on top of IT) inside the iliopsoas complex that spread to femoral, obturator, lateral femoral cutaneous, and genitofemoral nerve [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sensory testing of femoral, obturator, lateral femoral cutaneous, and genitofemoral nerve dermatomes revealed sufficient level of anesthesia. However, it was pointed out by a correspondence letter [ 73 ] that the authors actually performed an intramuscular injection of iliopsoas complex due to incorrect structural interpretation of ultrasound image. m High-volume (35 mL) PENG block was combined with sciatic nerve block to provide anesthesia of distal tibia and fibula fracture surgery and cover thigh tourniquet pain.…”

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confidence: 99%

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Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks

et al. 2022

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Iliopsoas plane (IP) is a fascial plane deep to the iliopsoas complex that can serve as a potential space for the injection of local anesthetics to selectively block the articular branches of femoral nerve and accessory obturator nerve to the anterior hip capsule. Two highly similar ultrasound-guided interfascial plane blocks that target the IP, pericapsular nerve group (PENG) block and iliopsoas plane block (IPB), were both designed to achieve motor-sparing sensory block to the anterior hip capsule. However, the most recent evidence shows that PENG block can cause 25% or more of quadriceps weakness, while IPB remains the hip block that can preserve quadriceps strength. In this scoping review of quadriceps weakness after PENG block and IPB, we first performed a focused review on the complicated anatomy surrounding the anterior hip capsule. Then, we systematically searched for all currently available cadaveric and clinical studies utilizing PENG block and IPB, with a focus on quadriceps weakness and its potential mechanism from the perspectives of fascial plane spread along and outside of the IP. We conclude that quadriceps weakness after PENG block, which places its needle tip directly deep to iliopsoas tendon (IT), may be the result of iliopectineal bursal injection. The incidental bursal injection, which can be observed on ultrasound as a medial fascial plane spread, can cause bursal rupture/puncture and an anteromedial extra-IP spread to involve the femoral nerve proper within fascia iliaca compartment (FIC). In comparison, IPB places its needle tip lateral to IT and injects just one-fourth of the volume of PENG block. The current evidence, albeit still limited, supports IPB as the true motor-sparing hip block. To avoid quadriceps weakness after PENG block, a more laterally placed needle tip, away from the undersurface of IT, and a reduction in injection volume should be considered. Future studies should focus on comparing the analgesic effects and quadriceps function impairment between PENG block and IPB.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%