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Poster displayed – Peripheral nerve blocks
P259 A-PENG and PONG as anesthetic technique for hip endoprosthesis surgery with posterolateral approach: a case description
  1. Impalà Giulia1,
  2. Del Buono Romualdo2,
  3. Pascarella Giuseppe3 and
  4. Tognù Andrea2
  1. 1Anesthesia and Intensive Care, Emergency Department, Fondazione IRCSS Policlinico San Matteo, Pavia, Italy
  2. 2Unit of Anesthesia, Resuscitation, Intensive Care Unit and Pain Management, ASST Gaetano Pini, Milan, Italy
  3. 3Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Hip surgery typically utilizes general or spinal anesthesia as the main anesthetic technique. We hereby describe a patient who underwent hip endoprosthesis in which an anterior (A-PENG) and posterior (PONG) ultrasound guided pericapsular infiltration has been performed along with additional local anesthetic (LA) skin infiltration, avoiding both general and spinal anesthesia.

Methods A 77-year-old ASA 2 patient with left hip fracture was scheduled for endoprosthesis surgery by posterolateral approach (PLA). Informed consent is obtained. After premedication with 100μg fentanyl and 3mg midazolam, in supine position, the A-PENG was performed: the probe was placed anteriorly along the axis of the femur neck, then 10ml 2% mepivacaine+adrenaline +10ml 0,75%ropivacaine were injected in the pericapsular plane (FIG 1). After turning the patient on the counterlateral side, the PONG was performed: the probe was placed transversely between the greater trochanter and the ischial tuberosity, targeting the plane below the quadratus femoris. Here, 10ml of anesthetic mixture were injected. The trochanteric insertion of the piriformis, the skin and subcutaneous tissue infiltration has been performed with the remaining 10ml of anesthetic mixture diluted with 10ml of saline. Sedation with propofol TCI was carried out throughout surgery.

Results Surgery was performed uneventfully. No pain was recorded up to 24h after surgery. Standard analgesic regimen consisted of paracetamol 3g/day+ketorolac 90mg/day. The addition of adrenaline reduced intraoperative blood losses.

Conclusions This approach allowed the avoidance of both general and spinal anesthesia, assuring adequate pain control without motor impairment.

Abstract P259 Figure 1
Abstract P259 Figure 1

A-PENG: a view of the acetabulum (right), the head (middle) and the neck (left) of the femur should be obtained, as well as a view of the overlying hip capsule and the iliopsoas muscle

Abstract P259 Figure 2
Abstract P259 Figure 2

PONG: a view of greater trochanter and ischial tuberosity should be obtained. A correct diffusion plane under the quadratus femoris should elevate it. In this picture, the probe has been slightly rotated to prevent trochanter-needle contact

Abstract P259 Figure 3
Abstract P259 Figure 3

Skin and subcutaneous infiltration on the surgical incision line

https://doi.org/10.1136/rapm-2024-ESRA.462

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