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An out-of-plane approach for pericapsular nerve group block: A case series
Ashok Jadon, Neelam Sinha, Swastika Chakraborty, Asif Ahmad
Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Jamshedpur, Jharkhand, India
Correspondence Address:
Ashok Jadon,
Duplex-63, Vijaya Heritage Phase-6, Kadma, Jamshedpur - 831 005, Jharkhand
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/BJOA.BJOA_41_20
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Pericapsular nerve group (PENG) block is a new ultrasound (US)-guided nerve block, which has been used successfully to manage fractured hip pain. As an alternative approach to give PENG block, we have investigated the out-of-plane (OOP) approach instead of the in-plane approach, which is conventionally used. Ten patients aged between 55 and 72 years scheduled for hip surgery under spinal anesthesia were given US-guided PENG block by the OOP approach. The success of block was assessed by reduction in rest pain and pain during 15° straight leg raising (SLR) (passive SLR test) on a numeric rating Score (NRS) after 30 min of block. Ease of positioning score was also assessed during spinal anesthesia. The procedural difficulty was assessed by the number of attempts (needle re-insertion at the skin). All patients had successful blocks and showed a significant pain relief in resting pain (6.5 ± 1.3 vs. 3.8 ± 0.78) as well as pain during 15° SLR (8.5 ± 1.1 vs. 5.1 ± 0.73). All blocks required single needle entry; however, in three patients, medial redirection of the needle was required before final positioning. No complication was observed in any case. PENG block provides effective analgesia during positioning for spinal anesthesia in patients with hip fracture. OOP approach can easily be used as an alternative to conventional in-plane technique.
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