Background and Aims Postoperative pain management in older patients is challenging due to several factors, including disease related changes in physiology and disease-drug and drug-drug interactions (1). Inadequate treatment of pain is associated with undesired effects (2). However, the use of opioid drugs may also lead to complications in older patients (3).
Pericapsullar nerve group (PENG) block is a novel block that targets articular branches of the accessory obturator nerve and femoral nerve, which has been shown to have a major role in the innervation of the hip capsule (4). In this case, we describe our experience with the continuous PENG block in an elderly patient.
Methods A 77-year-old ASA III woman with Alzheimer’s and Parkinson’s diseases was presented for hip surgery because of fracture. Following general anesthesia induction, PENG block was performed using an 80 mm needle with ultrasound guidance; 20 mL, 0.25% bupivacaine was injected in the space between the psoas tendon and the iliopubic eminence. At the end of the surgery, a catheter was inserted and infusion of 8 mL/h 0.1% bupivacaine was started, in addition 1 gr paracetamol and 20 mg tenoxicam was administered IV.
Results Patient was pain free in the postoperative 48 h period. No additional analgesic drug was needed and infusion was stopped after 48 h.
Conclusions This case showed that continuous PENG block via catheter provided pain free analgesia without the need of opioids in an elderly patient. However, we think that future randomized controlled trials are needed.
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