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Background and Aims The PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It is performed prior to surgery and covers the innervation of the anterior aspect of the hip joint, where much of the pain originates in this type of surgery. Although most nociceptive receptors are located in the anterior capsule, we should not ignore nociceptive stimulation in the posterior capsule. To address this, it is suggested to combine the PENG block with a preoperative intracapsular block.

Methods We performed a PENG block by administering 15 mL of 0.375% levobupivacaine to the bony edge of the ileum plus injection of 5 mL of the same local anesthetic at equal concentration into the hip joint capsule in two patients with the follow characteristics: - 89 years old male with basicervical left hip fracture scheduled for percutaneous surgery with PFNA nail. - 77-year-old woman with pertrochanteric hip fracture scheduled for percutaneous Gamma nail surgery.

Results Both of the patients were mobilized without any pain, achieving comfort while mobilization and positioning, as well as better perioperative pain control.

Conclusions Intracapsular block with intra-articular injection of 5 mL of local anesthetic covers the posterior nociceptive capsular fibers, guaranteeing total analgesia of the hip joint during perioperative mobilization. The PENG block complemented by the intracapsular block in the preoperative period allows for painless mobilization and positioning of the patient, and is useful if there is a need to sit down if neuraxial anesthesia is difficult to administer in the lateral decubitus position.