The Pericapsular Nerve Group Block for Perioperative Pain Management for Hip Arthroscopy

Abstract

Perioperative pain control for hip arthroscopy procedures represents a significant challenge for both surgeons and anesthetists. In light of the opioid crisis, greater emphasis has been placed on multimodal pain control techniques. There is considerable debate regarding regional nerve blockade for hip arthroscopy. Although regional anesthesia has a significant role in perioperative pain management strategies, many of the most common techniques present their own risks and limitations. In particular, the less desirable effects of postoperative weakness in the lower extremity and difficulty with ambulation are commonly produced with standard regional blockades. We present a technique for performing a targeted, sensory nerve block that can be done efficiently and safely in the immediate preoperative period. This block can potentially lower the intraoperative and postoperative opioid requirements without the risks of muscle blockade and falls from other regional anesthesia modalities.

© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.

Figures

Fig 1

Pericapsular nerve group block patient positioning. (A) The patient is supine, with his right hip exposed for the block, his head is to the right of the image. Slight hip flexion is achieved from a folded blanket placed behind the knee. (B) The patient is supine with his head to the top of the image, the right ASIS is palpated then marked with a surgical marker to identify the ultrasound starting position. ASIS, anterior inferior iliac spine.

Fig 2

Pericapsular nerve group block ultrasound probe starting position. (2A) The patient is supine with his head to the top of the image. The linear probe in placed longitudinally over the right ASIS. (2B) The ultrasound view of the right hip with the left side of the image corresponding to the superior pole of the probe with labeled ASIS. ASIS, anterior inferior iliac spine.

Fig 3

Pericapsular nerve group block ultrasound probe injection position. (3A) The patient is supine with his head to the top of the image with the probe aligned with right pubic ramus. (3B) The ultrasound view of the right hip with the left of the image corresponds to the now-superolateral pole of the probe. Key anatomic structures are labeled: AIIS, anterior inferior iliac spine; FA, femoral artery; FV, femoral vein; Psoas, psoas tendon.

Fig 4

Pericapsular nerve group block needle position and trajectory and post injection ultrasound image. (4A) The patient is supine with his head toward the bottom of the image, the probe is aligned with right pubic ramus, and the needle is inserted at a 50° angle from lateral to medial. (4B) The ultrasound view of the right hip, with the left side of the image corresponding to the superolateral pole of the probe. This image is following the 20 mL injection, demonstrating the increased fluid below the psoas tendon. AIIS, anterior inferior iliac spine; Psoas, psoas tendon.