Peng block in prosthetic hip replacement: A cadaveric radiological evaluation

Altınpulluk, Ece Yamak; Galluccio, Felice; Salazar, Carlos; Espinoza, Karla; Olea, Marilina Susana; Hochberg, Uri; Santiago, Jesus de; Pérez, Mario Fajardo

doi:10.1016/j.jclinane.2020.109888

Cited by 25 publications

(24 citation statements)

References 2 publications

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“…Recently, high-volume injectate (20 mL) may spread to the main trunk of the ON as the nerve courses along the lateral wall within the true pelvis through the intermuscular septum between the pectineus and psoas (20). Also, the dye includes the terminal articular branch of the inferomedial side of acetabulum (21). Moreover, several clinical reports have demonstrated the potential of the ON blocks in the case of a high-volume PENG block (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the analgesic efficacy of periarticular infiltration and pericapsular nerve group block for total hip arthroplasty: a randomized, non-inferiority study

Zheng¹,

Jo²,

Hwang³

et al. 2022

Ann Palliat Med

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Section: Discussionmentioning

confidence: 99%

Comparison of the analgesic efficacy of periarticular infiltration and pericapsular nerve group block for total hip arthroplasty: a randomized, non-inferiority study

Zheng¹,

Jo²,

Hwang³

et al. 2022

Ann Palliat Med

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“…Consequently, the altered fascial plane anatomy caused by the presence of the prosthesis becomes an important variable. Previously, Yamal Altinpulluk et al 12 have reported that contrast agent spreads differently with a prosthetic hip joint in situ. This would imply that the optimal volume for motor-sparing PENG block is context-dependent and may differ between THA and hip fracture repair (without prosthesis).…”

Section: Discussionmentioning

confidence: 99%

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

Kitcharanant

Leurcharusmee

Wangtapun

et al. 2022

Reg Anesth Pain Med

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BackgroundDuring total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves.Methods11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves.ResultsMethylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve.ConclusionSurgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.

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“…It is argued that the PENG block is an incomplete block as articular branches of the sciatic nerve innervating the posterolateral capsule of the hip joint are not captured by it (Sardesai & Biyani, 2020 ). Studies using dye in cadavers suggest that the drug spread to the posterior aspect of the hip thus covering the part of the sciatic nerve (Yamak Altinpulluk et al, 2020 ). There can be many anatomical rationales for the spread of the drug to different parts around the hip joint (Yamak Altinpulluk et al, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

“…Studies using dye in cadavers suggest that the drug spread to the posterior aspect of the hip thus covering the part of the sciatic nerve (Yamak Altinpulluk et al, 2020 ). There can be many anatomical rationales for the spread of the drug to different parts around the hip joint (Yamak Altinpulluk et al, 2020 ). Mistry et al performed over 200 blocks, and based on their experience, they divided needle insertion areas into 3 zones and coloured them in white, grey, and black to present the risks associated with needle entry through them (Mistry & Sonawane, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

Pericapsular nervegroup (PENG) block—a scoping review

Kaur

Saikia

Dey

et al. 2022

Ain-Shams J Anesthesiol

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The obturator nerve and its accessory branch supplying the hip region, unlike the femoral nerve, are not adequately anaesthetized by conventional regional anaesthetic techniques targeting the hip region. With advancements in ultrasound-guided regional anaesthetic techniques, interests are revived in the field and efforts are being made to block them together. One such successful attempt is the novel peri-capsular nerve group (PENG) block. Consequently, further research on the PENG block began to explore its versatilities. The present study undertakes a scoping review of research on the PENG block in humans for any indication to determine the extent of the research done, the methodologies used, and other practical issues addressed in the research. This will help to identify potential research gaps that should be addressed in the future. PubMed, Google Scholar, Cochrane Library, KoreaMed, Latin American and Caribbean Health Science Literature, and the directory of open access journals were searched with the keyword “PENG block” and “pericapsular nerve group”. Manual search of electronically retrieved papers was also carried out. Among the 67 articles selected in our review, eighteen are case series; twenty-nine are case reports; two are randomized studies; one each of prospective cohort study, review, and cadaveric study; and 15 are editorials. However, only 64 articles were included later due to the retraction of three case reports. Data is insufficient to provide firm recommendations for or against different aspects of the block. The review encourages future work addressing different aspects of the PENG block.

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Peng block in prosthetic hip replacement: A cadaveric radiological evaluation

Cited by 25 publications

References 2 publications

Comparison of the analgesic efficacy of periarticular infiltration and pericapsular nerve group block for total hip arthroplasty: a randomized, non-inferiority study

Comparison of the analgesic efficacy of periarticular infiltration and pericapsular nerve group block for total hip arthroplasty: a randomized, non-inferiority study

Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study

Pericapsular nervegroup (PENG) block—a scoping review

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