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

Abstract

BackgroundPubic rami fractures are painful injuries more commonly seen in the elderly with osteoporosis after high velocity trauma. In the most cases, management is conservative and non-operative with the goal to provide optimal pain relief to facilitate early mobilization and hospital discharge. Unfortunately, opioids remain the mainstay analgesic option and regional anesthesia techniques are limited but may include lumbar epidural anesthesia.Case presentationA female patient in her 80s presented to the emergency department of a level 1 trauma center following a high-speed motor vehicle collision. The patient suffered multiple non-life-threatening injuries. Notably, the patient was experiencing severe right groin and leg pain secondary to superior and inferior pubic rami fractures. Due to the severity of this pain, the patient was unable to mobilize or participate with physiotherapy. A lumbar epidural anesthesia technique was not deemed suitable and instead, we inserted a continuous pericapsular nerve group (PENG) block with a programmed intermittent bolus regimen. Immediate relief of pain was achieved and 48 hours later, the patient still reported satisfactory pain control and started to independently mobilize.ConclusionAnalgesia options are limited in pubic rami fractures. We present the first published case of a novel use of the PENG block with a continuous catheter technique for the analgesic management of a traumatic superior and inferior pubic rami fracture. The clinical utility of this technique in pubic ramus fractures warrants further clinical investigation.

Latest Advances in Regional Anaesthesia

“…This nerve block targets the articular branches of the femoral, obturator, and accessory obturator nerves to the hip capsule while sparing the motor branches [85]. A recent case report described the successful implementation of this block by an acute pain service for a patient with traumatic superior and inferior public rami fractures, allowing the patient to mobilise [86]. This finding is echoed in another case series of PENG blocks for pelvic bone fractures, involving in one case an inferior pubic rami fracture and in another case both superior and inferior public rami fractures.…”

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“…Вызывают интерес появившиеся публикации клинических случаев, свидетельствующие об эффективности применение PENG-блока для обезболивания переломов костей таза, что может свидетельствовать о перспективах применения данной блокады при хирургических вмешательствах, сопровождающихся остеотомиями костей таза [63][64][65].…”

Response to: Moorthy, Aneurin,et al‘Novel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report’—Regional Anesthesia, Pain Medicine (2022)

“…We congratulate doctors Moorthy et al for their article ‘Novel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report’,1 and welcome the multiple issues that this has highlighted. Data from Ireland reflect the changing face of trauma, with the biggest demographic sustaining major traumatic injuries now the older population 2.…”