Journal of Clinical Anesthesia 59 (2020) 3–4

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Journal of Clinical Anesthesia

journal homepage: www.elsevier.com/locate/jclinane

Correspondence

Pericapsular Nerve Group (PENG) block for perioperative pain control in hip arthroscopy T

As in any surgical procedure, one of the main goals of the anesthesia
team in arthroscopic surgery of the hip is to maintain low levels of
postoperative pain while minimizing the use of opiate-based medica-
tions [1,2]. Regional anesthesia techniques are widely used due to their
proven efficacy in postsurgical pain management and safety profile that
finally contributes to early recovery [1,2].
Postoperative pain related to hip arthroscopy originates from dif-
ferent locations around the joint such the acetabular labrum and fe-
moral neck among others or can be stimulated by the manipulation of
the trocars through the arthroscopic portals [1,2]. Femoral nerve (FN)
and fascia iliaca blocks have shown good results for sustained post-
surgical analgesia. However, the obturator nerve and the accessory
obturator nerve (AON) should also be targeted to achieve a more ef-
fective perioperative pain control [1,2].
Recently, Girón et al. [3] described a new technique for regional
anesthesia intended for pain control in hip fractures. This ultrasound-
guided technique, named by the authors as the PENG (Pericapsular
Nerve Group) block, includes the blockade of sensitive branches of the
FN and AON in a single-injection [3]. Following this publication, Ue-
shima and Otake [4,5] documented their successful clinical experience
using the PENG technique in four patients for perioperative pain
management in a hip joint dislocation reduction [5] and a hip re-
placement surgery [4].
Here, we present our experience in perioperative pain control using
the PENG block technique in addition to FN block in five patients un-
dergoing hip arthroscopy.
We used the PENG block in five consecutive patients, three women,
and two men, during the first trimester of 2019 in our center. All

Fig. 1. Ultrasound image of the PENG block. The image

shows the sonographic landmark structures and the angle
of insertion of the needle during the PENG block. The
arrow shows the pathway of the needle into the area
marked by the asterisk (*) where the solution is injected
between the psoas tendon and the iliopubic eminence.

https://doi.org/10.1016/j.jclinane.2019.04.037
Received 13 April 2019; Received in revised form 16 April 2019; Accepted 26 April 2019
0952-8180/ © 2019 Elsevier Inc. All rights reserved.
Correspondence
patients required surgery to repair femoroacetabular impingement
(FAI) and labral tears. The patients were put under general anesthesia
sustained with sevoflurane at 0.7 MAC (minimum alveolar concentra-
tion) without intraoperative infusion or boluses of opioids.
The PENG block guided by ultrasound was performed by any of the
anesthesiologist of our anesthesia and analgesic intervention group
following the description given by Girón et al. [3]. Concisely, with the
patient in supine position and under general anesthesia, a curve low-
frequency ultrasound probe was positioned over the anterosuperior
iliac spine and then rotated to 45° to obtain the projection from lateral
to medial of the anterior inferior iliac spine, iliopubic eminence, psoas
tendon, and the femoral artery (Fig. 1). Holding the probe at this po-
sition and after checking for negative aspiration using a 100 mm and 20
gauge needle, a solution containing 20 ml of 0.75% bupivacaine and 1%
lidocaine both without epinephrine, was injected in the space between
the iliopubic eminence and psoas tendon (Fig. 1). The FN block was also
performed under ultrasound guidance using 20 ml of a solution con-
taining lidocaine 1% (100 mg) and bupivacaine 0.75% (75 mg) without
epinephrine.
All patients with an average age of 48 ± 4.8 years were categorized
as ASA II. The highest level of pain assessed through the visual analog
scale (VAS) was three while in the recovery room and up to 24 h
postsurgery. After 48–72 h of the procedure, all patients had none or
very low level of pain (VAS 1) with no need for opioid analgesics. There
were no complications.
Our results showed successful perioperative pain control using the
PENG block technique for hip arthroscopic surgical procedures in adult
patients. Prospective studies with an experimental design are needed to
assess the effectiveness of this technique. Meanwhile, these results are
encouraging and support the use of the PENG block in arthroscopic
procedures of the hip.
We obtained written consent from all five patients. There are no
conflicts of interest.
⁎
Corresponding author at: Clínica del Campestre, Calle 17 Sur #4-46, Medellín, Colombia.
Journal of Clinical Anesthesia 59 (2020) 3–4
Disclosures
Funding
This study did not require funding.
Declaration of competing interest
None.
References
[1] Steinhaus ME, Rosneck J, Ahmad CS, Lynch TS. Outcomes after peripheral nerve
block in hip arthroscopy. Am J Orthop 2018;47:1–12. https://doi.org/10.12788/ajo.
2018.0049.
[2] Shin JJ, McCrum CL, Mauro CS, Vyas D. Pain management after hip arthroscopy:
systematic review of randomized controlled trials and cohort studies. Am J Sports
Med 2018;46:3288–98. https://doi.org/10.1177/0363546517734518.
[3] Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group
(PENG) block for hip fracture. Reg Anesth Pain Med 2018;43:859–63. https://doi.
org/10.1097/AAP.0000000000000847.
[4] Ueshima H, Otake H. Clinical experiences of pericapsular nerve group (PENG) block
for hip surgery. J Clin Anesth 2018;51:60–1. https://doi.org/10.1016/j.jclinane.
2018.08.003.
[5] Ueshima H, Otake H. Pericapsular nerve group (PENG) block is effective for dis-
location of the hip joint. J Clin Anesth 2019;52:83. https://doi.org/10.1016/j.
jclinane.2018.09.022.
Sergio Orozcoa, David Muñoza, Santiago Jaramilloa,
Ana Milena Herrerab,
⁎
a
Anesthesia and analgesic intervention group, Department of Anesthesia,
Clínica del Campestre, Medellín, Colombia
b
Department of epidemiology and clinical research, Clínica del Campestre,
Medellín, Colombia
E-mail address: anestesia@clinicadelcampestre.com (A.M. Herrera).