The PENG Block Tips
NYSORA, Inc.
Covering exclusive content, illustrations, and events in #Anesthesiology, #Ultrasound, #MSK, and #PainMedicine
Dear NYSORA Community,
Thank you for your subscription to the NYSORA newsletter, where we share information that matters to YOU, our community. In this edition, we're shedding light on pain management in hip surgery - the Pericapsular Nerve Group (PENG) block. This new technique is fast becoming the go-to method for interventional analgesia, particularly in total hip replacement surgeries using the anterior approach. So, let’s discuss the essence of the PENG block, its benefits, and NYSORA’s standardized approach in 3 steps that ensure safety and efficacy.
The Rise of the PENG Block
The PENG block has facilitated postoperative pain management for patients undergoing hip surgery. Its motor-sparing qualities make it suitable for rapid recovery without compromising mobility. Described based on anatomical studies, the PENG block targets the articular branches of the femoral, accessory obturator, and obturator nerves. These branches are effectively blocked between the anterior inferior iliac spine and the iliopubic eminence, a technique supported by cadaver studies that demonstrated the successful reach of methylene blue injections to these nerves.
Navigating the Procedure with Precision
Despite its apparent simplicity, the PENG block is not without its risks, which include potential injury to the femoral artery and nerve, as well as the dangers of needle insertion into the pelvic cavity. To mitigate these risks, Dr. Hadzic and his team teach a standardized NYSORA approach. To visualize the relevant anatomy for PENG block, here’s NYSORA’s three-step ultrasound imaging strategy:
Identify the femoral artery and NERVE at the femoral crease.
Slide the Transducer Proximally to identify the pubic ramus and anterior inferior iliac spine.
Tilt the Transducer Caudally to optimize the image of the psoas tendon, minimizing the risk of nerve injury and incorrect needle insertion.
Standardizing Success with the Right Tools
Success in the PENG block doesn't just rely on technique but also on utilizing the correct equipment. Dr. Hadzic emphasizes the importance of standardized tools to achieve the best outcomes. These include:
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An 8 cm long stimulating needle
Nerve stimulator monitoring for safety: to detect accidental needle-femoral nerve contact
10 mL of 0.5% bupivacaine for analgesia (can mix with EXPAREL 10 mL for longer block duration).
An injection pressure monitor to prevent injection into the psoas tendon.
The EZCOVER? ultrasound probe cover, featuring a "STOP before your block" sticker, acts as a final checkpoint to prevent blocks on the incorrect side, enhancing patient safety.
To see EZCOVER? in action, visit: catalogs.bbraun.com
The PENG Block and Innovation in Analgesia
The PENG block represents a significant leap forward in the field of interventional analgesia for hip surgery. We are committed to keeping you informed about the latest developments in our field, and we hope this insight into the PENG block has been useful. Remember, at NYSORA, we're more than a community; we're a network dedicated to advancing the frontiers of anesthesiology and pain management together.
Warm regards,
Dr. Hadzic and the NYSORA Team
To watch the PENG BLOCK video with the described techniques: YouTube.
Healthcare Consultant at Midland Regional Hospital Tullamore, Tullamore, Ireland
1 个月Even though it is projected as a motor sparing block, but there are some reported cases of motor blocks. Although motor blocks with PENG block is mostly dependent on injected volume. I have found it very useful in my practice and am very satisfied.