Continuous pericapsular nerve group (PENG) block through an elastomeric infusion system, associated with the lateral cutaneous nerve block of the thigh for total hip arthroplasty

Amanda Oliveira da Costa, Guilherme Vazquez Izolani, Iorle Fabiano Monteiro de Souza, Bruno Vítor Martins Santiago, Amanda Oliveira da Costa, Guilherme Vazquez Izolani, Iorle Fabiano Monteiro de Souza, Bruno Vítor Martins Santiago

Abstract

Orthopaedic surgeries can lead to pain that is difficult to treat, sometimes requiring prolonged hospitalisation. Peripheral nerve blocks stand out as an efficient strategy within the context of multimodal analgesia. The hypothesis is that continuous pericapsular nerve group block, when combined with lateral femoral cutaneous nerve block, can provide excellent analgesic coverage for hip surgeries. Continuous infusion systems can prolong analgesia, minimising opioid consumption, adverse effects and providing faster recovery. We describe a case of efficient analgesia, in which a catheter was positioned between the iliopsoas muscle plane and the iliopubic eminence for total hip arthroplasty.

Keywords: anaesthesia; hip prosthesis implantation; osteoarthritis; pain; rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© BMJ Publishing Group Limited 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
(A) Needling through the technique in plane with Tuohy 18G needle and linear USG probe. (B) Structures visualised during the PENG block. (C) Catheter passage through needle, 3 cm below the ilibicobic tendon. (D) Confirmation of positioning using the colour Doppler feature of the USG. AIIS, anteroinferior iliac spine; FA, femoral artery; FN, femoral nerve; IPE, iliopubic eminence; PENG, pericapsular nerve group; PT, iliopsoas tendon.
Figure 2
Figure 2
Local anaesthetic continuous infusion system—elastomeric pump (EasyPumpII LT B| Braun), with fixed flow rate of 2 mL/hour and capacity of 270 mL.
Figure 3
Figure 3
Graph demonstrating pain intensity, through the VNS, in fixed periods (6, 12, 18, 24, 30, 36, 42 and 48 hours), postoperatively. VNS, verbal numerical scale.

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