Pericapsular Nerve Group (PENG) block for hip analgesia

The PENG block is a pericapsular/periarticular hip block that can be used to provide analgesia of the hip joint region. For further technical tips - see • PENG Block - Tips n' T...
00:24 - Applied anatomy
01:55 - Technical performance
04:43 - Video - PENG with linear probe
05:39 - Video - PENG with curved probe
06:59 - Clinical pearls

[@brtkmsylr]

Thanks for your great description especially cadaveric examples and usg viewing 🙏🏻

[@moulaykarimdrissi]

Merci pour votre vidéo,claire,démonstrative et pratique .

[@drfranklin5638]

Insightful and well articulated. Thank you Prof Chin 🙏

[@ahmedkamal1256]

Very helpful presentation. The best I have seen for PENG block. Ahmed Abdelwahab Senior Anesthesiologists Australia-Melbourne

[@gorgi1998]

Excellent presentation.

[@eclampsium]

Thank you Mr!

[@esraanasser8377]

very useful video thank you ❤

[@Joclaim1]

Great presentation

[@jessicaburjorjee3460]

Thank you for the great description of the innervation of the hip capsule and clear technical advice. I am wondering if the PENG block is better suited to intracapsular (femoral neck) fractures then to extracapsular (inter/sub trochanteric) fractures. Would you prefer to do a modified FIB block per your other youtube video for an sub/intertrochanteric fracture instead as it seems to involve more femoral nerve innervation? Thanks for your thoughts on this decision making.

[@KiJinnChin]

Hi Jessica - I don't have access to good evidence at this time, but your thought process is logical, and I do tend to agree. At this time I would do a femoral-fascia iliaca block for fractures distal to the trochanteric line, and accept that there will be quadriceps weakness with this.

[@drsripadagmehandalekshema8570]

Thanks for the video

[@drsripadagmehandalekshema8570]

Very helpful

[@anesthesiologistma8373]

Helpful, thanks

[@jeajea]

How do you avoid quadricep weakness if part of the femoral nerve is being blocked as well?

[@KiJinnChin]

You have to ensure during injection that the local anesthetic is not spreading upwards through the psoas muscle, and thus towards the femoral nerve. If you see this, stop injecting, and try to advance the needle deeper below the iliopsoas fascia. A rotatory "drilling" motion of the needle is advocated by Dr Philip Peng to help this. The injection pressure can be very high when in this extra-muscular location.

[@NHL8S]

As all your exceptional videos brilliant, clear, perfectly structured and provided with intuitive visual material. One question: why we inject in medial direction when we want a lateral spread?

[@KiJinnChin]

Dr Peng is trying to promote spread to obturator branches which are hardest to get to. Also - most of the time we want to avoid involvement of the femoral nerve and quads weakness. This is a risk if the injection is too shallow and LA permeates through iliopsoas muscle. This risk is likely higher if there is lateral spread.

[@BIZDAZ1]

Excellent video and articulate presentation, as always. What are the indications for this block? Would it be useful for patient positioning in hip fracture prior to spinal. Thnks in advance

[@ahmedkamal1256]

Here is the answer of your question bro www.hindawi.com/journals/cria/2020/1830136/

[@biswajitdas-vx2yw]

Thnks a lot

[@peterkucharas2483]

I’ve done TFN with just a peng block and light propofol

[@chandrikakamath2707]

Excellent as always. I read in an article that there's a possibility of injuring the ureter. Dr Chin, please could you guide and shed light on this?

[@Dr.Twisty]

Dr. Chin-truly outstanding video!!! I’ve been using the PENG NB in a number of hip arthroscopies with excellent analgesia and no motor block. Do you feel the PENG NB would be effective in providing good analgesia in Total Hip Arthroplasties? Thanks!

[@KiJinnChin]

If your surgeons are doing effective intraoperative local anesthetic infiltration, I am not sure if it would offer any additional advantages. For this reason it is not currently part of my routine practice in THA. Perhaps if more evidence comes out...

[@Dr.Twisty]

@@KiJinnChin Would the PENG block cover the area of the femur where the stem is placed? It would be a really interesting study to compare it to current practice with surgeon administered local.