Indications
- Acetabular fracture
- Femoral head fracture
- Femoral neck fracture
- Pelvic rami fracture
- Hip dislocation
- Coverage limitation: Coverage may be variable for more lateral femoral neck, intertrochanteric, subtrochanteric, or femoral shaft fractures. The PENG block may be insufficient in these situations, and a fascia iliaca block may be preferred.
Contraindications
- Infection overlying injection site
- Allergy to local anesthetic
Equipment
- 20cc of local anesthetic of choice
- The PENG block is motor-sparing, but motor blockade has been reported with volumes greater than 20cc
- 18-22G, 3.5in spinal needle
- Cleansing solution
- Ultrasound with low-frequency curvilinear or high-frequency linear transducer
- Ultrasound transducer sterile cover
Preparation
Anatomy
Position
- Document a neurovascular examination before performing the block
- Position the patient supine with the affected extremity externally rotated
- Place the transducer parallel to the inguinal crease at an oblique angle, inferior and medial to the anterior inferior iliac spine
Ultrasound
Landmarks
- Identify the anterior inferior iliac spine and the iliopubic eminence
- Identify the hyperechoic iliopsoas tendon in the bony groove between these landmarks
- Identify the target plane between the iliopsoas tendon and the periosteum of the pubic ramus
Technique
- Create a local anesthetic skin wheal at the insertion site
- Using in-plane needle visualization, advance the needle from lateral to medial
- Advance to bone just proximal to and underneath the iliopsoas tendon
- Deposit approximately 20cc of local anesthetic in this plane
- Visualize the iliopsoas muscle, tendon, and fascia lifting from the periosteum of the bony pelvis
Examples
