Journal of Clinical Anesthesia 59 (2020) 42–43
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Journal of Clinical Anesthesia
journal homepage: www.elsevier.com/locate/jclinane
Correspondence
Pericapsular nerve group (PENG) block for surgical anesthesia of medial thigh☆
Dear Editor;
We read with great interest Ueshima [1] and Orozco [2] corre-
spondences describing the use of the pericapsular nerve group (PENG)
block. The obturator nerve originates from the lumbar plexus with the
femoral nerve and provides motor and sensory innervations in the
nerve thigh region. The techniques described for the femoral nerve
block have shown that the obturator nerve and especially the accessory
branch cannot be adequately anesthetized [3,4]. It has been shown that
femoral and obturator nerves can be blocked with single injection at the
same time perform the pericapsular nerve group (PENG) block [5]. The
PENG block was first described by Giron-Arango et al. in 2018 and
reported in a few cases to control pain in hip surgery. [1,2,5]. To date
all reports about PENG block for postoperative analgesia management.
Here it we first report a successful surgical anesthesia experience with
PENG block in a patient with multiple comorbidities.
A written informed consent was obtained from the patient before
the procedure. The case was a 60 years old female patient with a mass
(78 cm × 57 cm) in the medial of the thigh. Patient medical history
included congestive heart failure (EF 25%), hypertension and diabetes
mellitus. We decided to perform PENG block for surgical anesthesia.
The curvilinear ultrasound probe was placed in a transverse plane on
the anterior inferior iliac spine and then aligned with the pubic ramus
☆
I and my co-authors declared that we have no conflict of interest.
https://doi.org/10.1016/j.jclinane.2019.06.021
Received 23 May 2019; Accepted 9 June 2019
0952-8180/ © 2019 Elsevier Inc. All rights reserved.
T
by rotating the probe approximately 45 degrees. Femoral artery,
iliopsoas and pectineus muscles appeared (Fig. 1). A 100 mm sonovi-
sible nerve block needle was advanced to iliopubic eminence on the
pubic ramus with in-plane technique. Following negative aspiration, a
total of 30 ml of local anesthetic solution (15 ml 0.5% bupivacaine and
15 ml 2% lidocaine) was injected between the psoas tendon and the
pubic ramus. After 5 min, sensory testing of the femoral nerve, ob-
turator nerve and lateral femoral cutaneous nerve dermatomes revealed
a sufficient level of anesthesia. Surgery was started 30 min after block.
During the operation only 1 mg midazolam was administered and no
additional opioids and sedatives required. Duration of the surgery was
45 min and the patient was well tolerated to the surgery and anesthesia.
Patient was discharged without any problem on the same day.
Innervation of the tight is carried out by lumbar plexus. While lat-
eral femoral cutaneous (L2−L3) innervates lateral part of thigh, ante-
romedial-distal thigh is innervated via femoral (L2-L4) and obturator
nerve (L2-L4). Since the dermatomal area of lesion includes both fe-
moral and obturator regions, we decided to make PENG block with
single injection in present case with 30 ml volume.
In conclusion; PENG block provides effective surgical anesthesia for
suitable dermatomal areas and selected patients. However cadaveric,
radiologic and clinical studies are required to determine the distribu-
tion and mechanism of PENG block.
Correspondence Journal of Clinical Anesthesia 59 (2020) 42–43

Fig. 1. A. Ultrasound, probe, needle and patient set up for PENG block, B. Surgical area and a mass in the medial of the thigh C. Sonographic anatomy. AIIS: anterior
inferior iliac spine, FA: Femoral artery, PE: pectineus muscle, IPE: iliopubic eminence.

References [5] Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular nerve group
(PENG) block for hip fracture. Reg Anesth Pain Med 2018;43:859–63.

[1] Ueshima H, Otake H. Pericapsular nerve group (PENG) block is effective for dis-
Ali Ahiskalioglua, , Muhammed Enes Aydina, Elif Oral Ahiskalioglua,
⁎
location of the hip joint. J Clin Anesth 2019;52:83.
[2] Orozco S, Munoz D, Jaramillo S, Herrera AM. Pediatric use of pericapsular nerve Kutsi Tuncerb, Mine Celika
group (PENG) block for hip surgical procedures. J Clin Anesth 2019;57:143–4. a
[3] Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the dis- Department of Anaesthesiology and Reanimation, Ataturk University
tribution of local anesthetic during the three-in-one block. Anesth Analg School of Medicine, Erzurum, Turkey
2000;90:119–24. b
Department of Orthopedic and Traumatology, Ataturk University School of
[4] Swenson JD, Davis JJ, Stream JO, Crim JR, Burks RT, Greis PE. Local anesthetic
injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of
Medicine, Erzurum, Turkey
distribution and effects on the obturator nerve. J Clin Anesth 2015;27:652–7. E-mail address: ali.ahiskalioglu@atauni.edu.tr (A. Ahiskalioglu).

⁎
Corresponding author at: Ataturk University School of Medicine, Yakutiye Research Hospital Department of Anesthesiology and Reanimation, 25070, Palandöken,
Erzurum, Turkey.

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