Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique

Abstract

Background: Pericapsular nerve group (PENG) block is a new ultrasound guided nerve block. It was used primarily to relieve pain in hip fracture; now, many new indications have been added. However, dependency on ultrasound guidance for this block limits its use where ultrasound facility is poor or not available. We have suggested a landmark based technique to increase the benefit of this novel nerve block. Aim and Objectives: To do a feasibility study to assess the successful placement of block needle, clinical efficacy of the block and block-related complications. Material and Methods: Total 10 patients (4 males and 6 females) with fracture hip and scheduled for hip surgery under spinal anaesthesia were selected for the study. In 4 patients ultrasound guided PENG block using out-of-plane approach and in 6 patients landmark based nerve stimulator guided block was given with 20ml 0.25% bupivacaine and 8mg dexamethasone. Pain relief before and after 30 minutes of block was assessed by numeric rating scale (NRS) and comfort during spinal position was assessed by ease of spinal position score (EOSP). Results: All 10 patients had successful block; NRS at rest was 6 (6-9) Vs 2 (0-2) and on 15 °limb elevation was 8 (8-10) Vs 3 (2-4). All patients could sit comfortably during spinal anaesthesia and median (range) EOSP sore was 3 (2-3). No complication was observed. Conclusion: Landmark based technique for PENG block is a feasible option and can be used safely where ultrasound facility is not available.

Peri-capsular nerve group block provides excellent analgesia in hip fractures and positioning for spinal anaesthesia: A prospective cohort study

“…[ 4 5 6 7 ] In addition to analgesic benefit, PENG block has been used in hip arthroscopy, hip dislocation and other indications. [ 8 ] Jadon et al . recently described landmark-based PENG block, which can further enhance its acceptability in places where anaesthesiologists have no access to ultrasound to perform this block.…”

“…also noticed the analgesic benefit and effect in making the patients sit comfortably for the conduct of SA. [ 8 ] What makes PENG block special from others is that it targets the articular branches innervating the anterior hip joint and does not lead to motor weakness if done properly. [ 2 ] Furthermore, the analgesic benefit is profound in terms of the median drop in pain score following the block.…”

PENG block

“…We have read with interest the article 'Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique,' by Jadon et al . [ 1 ] We want to congratulate them, as feasibility and safety of a landmark technique will contribute to a widespread use of this block[ 2 ] in situations of low ultrasound availability. They performed 4 of 10 blocks under ultrasound guidance in an out-of-plane approach, leading to optimal analgesia.…”

In response to, PENG block: Advantages of out-of-plane approach

“…We thank the readers for their interest in our recent publication and also supporting our point of view that, out-of-plane (OOP) approach is a feasible alternative and it will further enhance the utility of pericapsular nerve group (PENG) block. [ 1 2 ]…”

“…However, OOP approach can also be used with the help of nerve stimulator and landmark-based technique in low resource settings where ultrasound is not available. [ 2 ]…”