Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study

Hamra, Pedro; Sau, André Sanches; Ricioli Junior, Walter; Rabelo, Nayra Deise dos Anjos; Polesello, Giancarlo Cavalli

doi:10.1055/s-0042-1758367

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Original Article • Rev bras ortop 58 (4) • Jul-Aug 2023 • https://doi.org/10.1055/s-0042-1758367 linkcopy

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To evaluate the technical reproducibility of a block of the pericapsular nerve group (PENG) of the hip aided or not by ultrasound in cadavers.

Materials and Methods The present is a randomized, descriptive, and comparative anatomical study on 40 hips from 2 cadaver groups. We compared the PENG block technique with the method with no ultrasound guidance. After injecting a methylene blue dye, we verified the dispersion and topographical staining of the anterior hip capsule through dissection. In addition, we evaluated the injection orifice in both techniques.

Results In the comparative analysis of the techniques, there were no puncture failures, damage to noble structures in the orifice path, or differences in the results. Only 1 hip from each group (5%) presented inadequate dye dispersion within the anterior capsule, and in 95% of the cases submitted to either technique, there was adequate dye dispersion at the target region.

Conclusion Hip PENG block with no ultrasound guidance is feasible, safe, effective, and highly reliable compared to its conventional counterpart. The present is a pioneer study that can help patients with hip pain from various causes in need of relief.

Keywords
analgesia; anesthesia; hip joint; nerve block; cadaver; peripheral nerve injuries

Identification	Gender	Age (years)	Height (meters)	Weight (kilosg)
C1	Male	70	1.73	46
C2	Female	77	1.44	44
C3	Male	69	1.76	85
C4	Male	93	1.63	49
C5	Male	64	1.68	55
C6	Female	62	1.73	60
C7	Male	48	1.66	69
C8	Male	52	1.7	71
C9	Male	78	1.76	68
C10	Male	89	1.7	43

Identification	Gender	Age (years)	Height (meters)	Weight (kilos)
C11	Male	70	1.72	69
C12	Female	94	1.55	45
C13	Male	45	1.77	57.6
C14	Male	71	1.77	102
C15	Female	79	1.67	87
C16	Male	82	1.75	75
C17	Male	49	1.71	74
C18	Female	50	1.71	72
C19	Male	65	1.71	81
C20	Female	81	1.55	64

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C1	Yes	No	Yes	Yes
C2	Yes	No	Yes	Yes
C3	Yes	No	Yes	Yes
C4	Yes	No	Yes	Yes
C5	Yes	No	Yes	Yes
C6	Yes	No	Yes	Yes
C7	Yes	No	Yes	Yes
C8	Yes	No	Yes	Yes
C9	Yes	No	Yes	Yes
C10	Yes	No	Yes	No

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C11	Yes	No	Yes	Yes
C12	Yes	No	No	Yes
C13	Yes	No	Yes	Yes
C14	Yes	No	Yes	Yes
C15	Yes	No	Yes	Yes
C16	Yes	No	Yes	Yes
C17	Yes	No	Yes	Yes
C18	Yes	No	Yes	Yes
C19	Yes	No	Yes	Yes
C20	Yes	No	Yes	Yes

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Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[TFN1] Abbreviation: C, cadaver.

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C1	Yes	No	Yes	Yes
C2	Yes	No	Yes	Yes
C3	Yes	No	Yes	Yes
C4	Yes	No	Yes	Yes
C5	Yes	No	Yes	Yes
C6	Yes	No	Yes	Yes
C7	Yes	No	Yes	Yes
C8	Yes	No	Yes	Yes
C9	Yes	No	Yes	Yes
C10	Yes	No	Yes	No

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C11	Yes	No	Yes	Yes
C12	Yes	No	No	Yes
C13	Yes	No	Yes	Yes
C14	Yes	No	Yes	Yes
C15	Yes	No	Yes	Yes
C16	Yes	No	Yes	Yes
C17	Yes	No	Yes	Yes
C18	Yes	No	Yes	Yes
C19	Yes	No	Yes	Yes
C20	Yes	No	Yes	Yes

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C1	Yes	No	Yes	Yes
C2	Yes	No	Yes	Yes
C3	Yes	No	Yes	Yes
C4	Yes	No	Yes	Yes
C5	Yes	No	Yes	Yes
C6	Yes	No	Yes	Yes
C7	Yes	No	Yes	Yes
C8	Yes	No	Yes	Yes
C9	Yes	No	Yes	Yes
C10	Yes	No	Yes	No

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C11	Yes	No	Yes	Yes
C12	Yes	No	No	Yes
C13	Yes	No	Yes	Yes
C14	Yes	No	Yes	Yes
C15	Yes	No	Yes	Yes
C16	Yes	No	Yes	Yes
C17	Yes	No	Yes	Yes
C18	Yes	No	Yes	Yes
C19	Yes	No	Yes	Yes
C20	Yes	No	Yes	Yes

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study*

Block of the Pericapsular Nerve Group of the Hip with and without Ultrasound Guidance: Comparative Cadaveric Study^*

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C1	Yes	No	Yes	Yes
C2	Yes	No	Yes	Yes
C3	Yes	No	Yes	Yes
C4	Yes	No	Yes	Yes
C5	Yes	No	Yes	Yes
C6	Yes	No	Yes	Yes
C7	Yes	No	Yes	Yes
C8	Yes	No	Yes	Yes
C9	Yes	No	Yes	Yes
C10	Yes	No	Yes	No

Identification	Bone reached at first puncture	Neurovascular bundle hit	Right anterior capsule staining	Left anterior capsule staining
C11	Yes	No	Yes	Yes
C12	Yes	No	No	Yes
C13	Yes	No	Yes	Yes
C14	Yes	No	Yes	Yes
C15	Yes	No	Yes	Yes
C16	Yes	No	Yes	Yes
C17	Yes	No	Yes	Yes
C18	Yes	No	Yes	Yes
C19	Yes	No	Yes	Yes
C20	Yes	No	Yes	Yes