Point‐of‐care ultrasound‐guided pericapsular nerve group block for superior pubic ramus fracture in the emergency department: A case report

Abstract

Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard‐volume point‐of‐care ultrasound‐guided pericapsular nerve group (PENG) block performed in the emergency department. The standard‐volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.

Novel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report

“…On review of the literature, there has been one other case report,13 demonstrating successful use of a PENG block for the management of severe pain following a traumatic pubic ramus fracture. However, there are important differences between our case and the case report described by Cripps et al 13.…”

“…On review of the literature, there has been one other case report,13 demonstrating successful use of a PENG block for the management of severe pain following a traumatic pubic ramus fracture. However, there are important differences between our case and the case report described by Cripps et al 13. First, Cripps et al had initially performed a PENG block as an analgesic technique in the context for the suspicion of a neck-of-femur fracture on plain film X-ray.…”

Peri-Capsular Nerve Group Blocks in the Emergency Department (ED) - A Broad Overview

“…PENG block appears to be a safe procedure with no major complications reported by most studies [15,22,23]. Certain case reports and reviews demonstrate quadriceps muscle weakness, especially following large volume infiltration [22,24].…”

“… To minimize the risk of bladder injury, gather information about the patient's last urination and perform a negative aspiration test for urine before the procedure [30].  Avoid using large volumes of local anesthetic to prevent motor blockade [22,23].  Apply local anesthetic at the needle insertion site to monitor for paresthesia, and consider using an outof-plane (OUT) approach to reduce the likelihood of inadvertent injury to the lateral femoral cutaneous nerve (LFCN) [31,32].…”

“… Apply local anesthetic at the needle insertion site to monitor for paresthesia, and consider using an outof-plane (OUT) approach to reduce the likelihood of inadvertent injury to the lateral femoral cutaneous nerve (LFCN) [31,32]. [22][23][24][25][26].…”