Additionally, the motor function of the involved extremity should be spared. This proximal approach via ultrasound guidance can confer several advantages over a femoral nerve block by providing more complete analgesia to the hip joint. The ultrasound-guided PENG block allows for coverage of the hip joint, targeting the proximal articular branches that innervate the joint capsule. An appropriate plan for perioperative analgesia is challenging, but a multimodal approach including acetaminophen, cox-2 selective NSAIDs, regional anesthesia, and periarticular infiltration techniques improves patient outcomes. The hip joint has a complex innervation, and the pain following hip fractures or total hip arthroplasties is particularly severe.

Also, blocking the proximal innervations (femoral, sciatic, obturator, etc.) of all the terminal branches that innervate the hip joint would also result in significant weakness of the leg. The proximal location of these nerves may explain why patients experience incomplete analgesia from techniques such as the femoral nerve block alone. ДЄlthough less studied, the posteromedial portion of the joint capsule also likely has contributions from the nerve to the quadratus femoris and sciatic nerves.

Additionally, they identified articular contributions from the obturator nerve, consistent with previous findings that these articular branches primarily innervated the inferior and anteromedial aspect of the hip joint. Sakamoto and colleagues identified two articular branches to the hip joint derived from the femoral nerve, namely from the pectineus and iliopsoas muscles. The joint capsule itself is a complex arrangement of articular branches receiving contributions from the aforementioned nerves. Furthermore, the joint is largely supplied by the femoral, sciatic, and obturator nerves. This anatomical configuration provides mechanical stability and multidimensional motion.В The joint capsule itself is responsible for a majority of the pain experienced in the hip. The hip joint is a di-arthrodial articulation that connects the femur and the pelvis. Therefore the ideal block technique should provide complete analgesia of the hip joint and without muscle weakness. With the understanding that additional articular branches (i.e., from the sciatic nerve) these blocks will provide incomplete analgesia to the hip and may also predispose the patient to fall due to weakness of the quadriceps muscles.

Historically, the most commonly performed peripheral nerve blocks include lumbar plexus block, a femoral nerve block, or a fascia iliaca compartment block to manage post-operative analgesia. Operative intervention, such as THA, has also been associated with significant pain. These indications for surgery are relatively common in the elderly population and are associated with significant morbidity and mortality. The indications for THA often include degenerative hip disease and traumatic hip fractures. Furthermore, the blocking and understanding of the terminal nerves that innervate the hip joint have also been described in patients with chronic hip pain. The block is thought to provide more complete analgesia to the hip by depositing local anesthetic within the myofascial plane of the psoas muscle and superior pubic ramus. The pericapsular nerve group block (PENG) is a regional anesthetic technique described in 2018, developed primarily in total hip arthroplasties (THA) for postoperative analgesia with motor sparing benefits.

Ipack block cpt code