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Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study
  1. Nitchanant Kitcharanant1,
  2. Prangmalee Leurcharusmee2,3,
  3. Pakawat Wangtapun1,
  4. Perada Kantakam4,
  5. Naraporn Maikong4,
  6. Pasuk Mahakkanukrauh3,4 and
  7. De Q Tran5
  1. 1 Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  2. 2 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  3. 3 Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  4. 4 Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  5. 5 Department of Anesthesiology, St. Mary’s Hospital, McGill University, Montreal, Québec, Canada
  1. Correspondence to Dr Prangmalee Leurcharusmee, Department of Anesthesiology, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; prangmalee.l{at}cmu.ac.th

Abstract

Background During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves.

Methods 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves.

Results Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve.

Conclusion Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration.

  • nerve block
  • lower extremity
  • pain, postoperative

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Footnotes

  • Contributors NK, PL, PW, PK, NM and PM participated in the planning, conception, design, conduct, reporting, acquisition of data, data analysis and interpretation of data. DQT participated in the design, data analysis and interpretation of data. PL is a guaranter reponsible for the overall content.

  • Funding This study was funded by the Faculty of Medicine Research Fund (Grant No. 053-2565) of Chiang Mai University, Chiang Mai, Thailand.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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