Indian Journal of Pain

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 35  |  Issue : 2  |  Page : 179--180

Newer horizons for the pericapsular nerve group block


Priyanka Pavithran 
 Department of Anaesthesiology, Aster MIMS, Kozhikode, Kerala, India

Correspondence Address:
Dr. Priyanka Pavithran
Department of Anaesthesiology, Aster MIMS, Kozhikode, Kerala
India




How to cite this article:
Pavithran P. Newer horizons for the pericapsular nerve group block.Indian J Pain 2021;35:179-180


How to cite this URL:
Pavithran P. Newer horizons for the pericapsular nerve group block. Indian J Pain [serial online] 2021 [cited 2022 May 29 ];35:179-180
Available from: https://www.indianjpain.org/text.asp?2021/35/2/179/325207


Full Text



Sir,

Pericapsular nerve group (PENG) block is a novel regional anesthetic technique described for the management of pain in hip fracture patients. PENG block was described by Giron-Arango et al., where he performed the block with 20 mL of the drug.[1] This is an interfascial plane block which acts on the articular branches of femoral, obturator and accessory obturator nerves.

In this case report, we describe our experience with using high volume of local anaesthetic in PENG block for the perioperative management of a patient with right posterior column acetabular fracture. A 50-year-old male, weighing approximately 75 kg was posted for elective fixation of fracture acetabulum. It was decided to do the acetabular surgery under general anaesthesia with PENG block. Under standard monitors, he was induced with injection fentanyl 150 μg and injection propofol 150 mg and injection atracurium 40 mg. Following intubation with an endotracheal tube, the PENG block was administered under sterile precautions. A mixture of 20 mL 0.5% ropivacaine, 10 mL 2% lignocaine with adrenaline and 4 mg dexamethasone was prepared. A curvilinear, low-frequency probe was placed over the anterior superior iliac spine and then rotated 45° anticlockwise and aligned toward the inferior pubic ramus. A 22 G, 10 cm nerve stimulator needle was inserted in a lateral to medial direction with in-plane technique aiming for the plane between the psoas tendon and pubic ramus. After negative aspiration, 30 ml of the prepared mixture was administered slowly while watching for the spread. The patient was then positioned for the surgery in lateral decubitus. There was no tachycardia or hypertension on the incision and intraoperative analgesia was supplemented with injection paracetamol 1 g. No long-acting opioids were given. The surgery took 3 h and the patient remained hemodynamically stable. Postoperatively, the patient was very comfortable and his visual analog scores remained below 3 in the first 24 h. He did not require any rescue analgesics and was maintained on injection paracetamol 1 g eighth hourly.

Several reports have demonstrated the utility of PENG block in the perioperative management of hip surgeries.[2],[3] Most of the reports have shown the PENG block to be very useful in allowing the patients to be positioned comfortably for subarachnoid block.[4] Recently a study described the landmark technique for this block.[5] Tran et al. showed that the spread of the dye injected for the PENG block was more extensive as the volume of injectate increased.[6] High volume local anesthetic administration in PENG block being used for analgesia in acetabular fracture was shown in a report.[7] Similarly, injecting a large volume of the drug for PENG block is believed to act as a lumbar plexus block, but these findings were not confirmed by cadaveric studies or by injecting dyes.[8] These studies prompted us to make use of PENG block for analgesia for our case and it was found to be effective. More research with clinical and cadaveric studies is required to further explore the indications and volume of drugs needed for the PENG block.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Giron-Arango L, Peng PW, Chin KJ, Brull R, Perlas A. Pericapsular nerve group block for hip fracture. Reg Anaesth Pain Med 2018;43:859-63.
2Ueshima H, Otake H. Clinical experiences of pericapsular nerve group (PENG) block for hip surgery. J Clin Anesth 2018;51:60-1.
3Talawar P, Tandon S, Tripathy DK, Kaushal A. Combined pericapsular nerve group and lateral femoral cutaneous nerve blocks for surgical anaesthesia in hip arthroscopy. Indian J Anaesth 2020;64:638-40.
4Sahoo RK, Jadon A, Sharma SK, Peng PW. Peri-capsular nerve group block provides excellent analgesia in hip fractures and positioning for spinal anaesthesia: A prospective cohort study. Indian J Anaesth 2020;64:898-900.
5Jadon A, Sinha N, Chakraborty S, Singh B, Agrawal A. Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique. Indian J Anaesth 2020;64:710-3.
6Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Reg Anesth Pain Med 2019;44:247.
7Bilal B, Öksüz G, Boran ÖF, Topak D, Doğar F. High volume pericapsular nerve group (PENG) block for acetabular fracture surgery: A new horizon for novel block. J Clin Anesth 2020;62:109702.
8Ahiskalioglu A, Aydin ME, Celik M, Ahiskalioglu EO, Tulgar S. Can high volume pericapsular nerve group (PENG) block act as a lumbar plexus block? J Clin Anesth 2020;61:109650.