The PENG Block with Highland EM

The PENG block stands for PEricapsular Nerve Group block and looks to be a phenomenal block for hip and femoral neck fractures.  Hear all about it in this week’s podcast featuring Dan Mantuani, Rob Farrow and Josh Luftig. Check out the video below!

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  1. This is cool for ED purposes. But I’d imagine that for anaesthetic purposes the lack of a block of the femoral lateral cutaneous nerve would be an issue. what do you reckon?

  2. Thanks for a great video on the PENG block .. seems easy effective and safe indeed!
    A few questions..
    the indications would include pelvic fractures( including femoral neck ) … but how far distal would the spread go.
    Could it be used for trochanter fractures or even subtrochanter fractures?
    Would a combination of FICB & PENG beneficial and feasible?

    One remark on the FICB.. one of the reasons the analgesia is never 100% is that the dorsal aspect of the femoral neck and femur is supplied by the sciatic nerve.. how does the PENG block fix this?

    Love to hear your thoughts,

    Vincent

    1. From Rob Farrow:
      Hi Vincent, thank you for the great questions! In regards to the effective spread of anesthesia, I would likely only utilize the PENG block for pelvic fractures and femoral neck fractures as the main target of analgesia are the articular branches with variable involvement of the obturator nerve and femoral nerve depending on volume. Using a good volume I would anticipate pain relief when the PENG block is performed on intertrochanteric fractures. Based on the current available literature, I would not expect good anesthesia past the trochanter or femoral neck. In my practice for fractures extending further then these points I would utilize the FICB. Personally, I think there could be some utility in a combined FICB and PENG approach as it would guarantee a more complete block with spread over the femoral nerve, articular branches, obturator nerve and AON. While this is by no means enough evidence, I have used this combination in patients with severe hip fractures with good results. Anatomically I believe this approach has merit as long as a weight based approach is used for the anesthetic. Finally, you bring up an excellent point about the articular branches from the sciatic nerve. From the available literature, I would not anticipate that the PENG would catch these particular branches as well as the anterior articular branches from the femoral n., obturator n. and AON. That said, the PENG block still has merit as you get better medial spread over the AON, obturator nerve and their related articular branches while retaining motor function in the quadriceps muscle. The caveat being that this is all based on the available literature and studies. As the PENG block becomes more commonplace I would expect some of these questions to be answered. I hope this helps!

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