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Background and Aims Hip osteoarthritis management primarily focuses on rapid symptom control including pain alleviation and functional improvement. Ultrasound- guided regional anesthesia techniques targeting the branches of the anterior lumbar plexus have been performed in providing pain relief in chronic hip pain. However, despite these approaches, patients may experience residual posterior hip pain, which can be attributed to the posterior nerve supply of the hip. We present a case report of chronic hip pain successfully managed with posterior pericapsular deep-gluteal (PPD) block in addition to pericapsular nerve group (PENG) block.
Methods A 56-years old patient with a history of total hip arthroplasty presented to our pain clinic. Inspite of medication and physiotherapy management, the patients‘ numeric rating score was 6 at rest and 8 during movement. After three repeated PENG blocks within a one-month period, the pain localized to the posterior hip region. Consequently, we decided to perform PPD block (figure 1). Written consent was obtained from patient for the procedure and future publication.
Results After administering the PPD block in addition to the PENG block, the patients‘ NRS scores decreased to 2 at rest and 4 during movement. Additionally, the patients‘ functional capacity scores showed improvement (table 1).
Conclusions An additional PPD block can be beneficial in patients with residual posterior hip pain, even when anterior approaches have been performed. We suggest that PPD block targeting the superior gluteal nerve, nerve to the quadratus femoris muscle, and sciatic nerve in addition to the PENG block can be performed for more complete analgesia in chronic hip pain.
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