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Pericapsular nerve group block: a 3D CT scan imaging study to determine the spread of injectate
  1. Angela Lucia Balocco1,2,
  2. Nicolas Gautier3,
  3. Sam Van Boxstael1,4,
  4. Ana M López4,
  5. Michele Carella5,
  6. Kristoff Corten6,
  7. Xavier Sala-Blanch7,8,
  8. Admir Hadzic4 and
  9. Philippe Emmanuel Gautier3
  1. 1Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
  2. 2Anesthesiology, UZ Leuven, Leuven, Belgium
  3. 3Service d'Anesthésie-Réanimation, CHIREC, Brussels, Belgium
  4. 4Anesthesiology and Intensive Care, Ziekenhuis Oost-Limburg, Genk, Belgium
  5. 5Anesthesiology and Intensive Care, Centre hospitalier universitaire de Liege, Liege, Belgium
  6. 6Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
  7. 7Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  8. 8Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  1. Correspondence to Dr Angela Lucia Balocco, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; luchy88{at}


Background Current understanding of the mechanism of action of the pericapsular nerve group (PENG) block is primarily based on cadaver studies. We performed an imaging study in patients undergoing hip surgery to enhance the understanding of the analgesic mechanisms following a PENG block.

Materials and methods 10 patients scheduled for hip surgery received an ultrasound-guided PENG block with 18 mL of 0.5% ropivacaine mixed with 2 mL of a contrast agent. After completion of the block, a high-resolution CT scan was performed to obtain a three-dimensional reconstruction of the injectate’s dispersion.

Results The CT imaging revealed that injectate was mainly confined to the epimysium of the iliacus and the psoas muscle, with a minor spread to the hip capsule. Contrast dye was detected within the iliacus and/or the psoas muscle in all patients. No observed spread to either the subpectineal plane or the obturator foramen was detected.

Conclusion Our study suggests that the analgesic effect of the PENG block may be related to the block of the branches of the femoral nerve traveling within the iliopsoas muscle without a spread pattern commensurate with the block of the obturator nerve.

Trial registration number Registry (NCT06062134).

  • Ultrasonography
  • analgesia
  • Anesthesia, Local

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  • Contributors All authors contributed to the conceptualization, investigation, methodology, writing the original draft and writing (review and editing).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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