Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study.

Autor:	Kitcharanant N; Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Leurcharusmee P; Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand prangmalee.l@cmu.ac.th.; Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Wangtapun P; Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Kantakam P; Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Maikong N; Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Mahakkanukrauh P; Excellence in Osteology Research and Training Center (ORTC), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Tran D; Department of Anesthesiology, St. Mary's Hospital, McGill University, Montreal, Québec, Canada.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2022 Jun; Vol. 47 (6), pp. 359-363. Date of Electronic Publication: 2022 Mar 14.
DOI:	10.1136/rapm-2022-103482
Abstrakt:	Background: During total hip arthroplasty (THA) using the direct anterior approach, orthopaedic surgeons can identify all anatomical landmarks required for pericapsular nerve group (PENG) blocks and carry out the latter under direct vision. This cadaveric study investigated the success of surgeon-performed PENG block. Success was defined as dye staining of the articular branches of the femoral and accessory obturator nerves. Methods: 11 cadavers (18 hip specimens) were included in the current study. To simulate THA in live patients, an orthopaedic surgeon inserted trial prostheses using the direct anterior approach. Subsequently, a block needle was advanced until contact with the bone (between the anterior inferior iliac spine and iliopubic eminence). 20 mL of 0.1% methylene blue was injected. Cadavers were then dissected to document the presence and dye staining of the femoral, lateral femoral cutaneous, obturator and accessory obturator nerves as well as the articular branches of the femoral, obturator and accessory obturator nerves. Results: Methylene blue stained the articular branches of the femoral nerve and the articular branches of the accessory obturator nerve (when present) in all hip specimens. Therefore, surgical PENG block achieved a 100% success rate. Dye stained the femoral and obturator nerve in one (5.6%) and two (11.1%) hip specimens, respectively. No dye staining was observed over the accessory obturator nerve in the pelvis nor the lateral femoral cutaneous nerve. Conclusion: Surgeon-performed PENG block during direct anterior THA reliably targets the articular branches of the femoral and accessory obturator nerves. Future trials are required to compare surgeon-performed PENG block with anaesthesiologist-performed, ultrasound-guided PENG block, and surgeon-performed periarticular local anaesthetic infiltration. Competing Interests: Competing interests: None declared. (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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