Abstract
Background
Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block.
Methods
A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24 h later to assess the extent of dye spread.
Results
Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection.
Conclusion
The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data supporting the results reported in our paper can be provided on reasonable personal request to the corresponding author.
References
Scala VA, Lee LSK, Atkinson RE. Implementing regional nerve blocks in hip fracture programs: a review of regional nerve blocks, protocols in the literature, and the current protocol at the queen’s medical center in Honolulu, HI. Hawaii J Health Soc Welf. 2019;78(Suppl 2):11–5.
Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H, Van de Velde M. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth Pain Med. 2017;42:327–33.
Giron-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43:859–63.
Brown B, Lin D-Y, Saies A, Vermeulen M, Kroon HM, Doornberg J, Jaasma R. The pericapsular nerve group block for hip fracture surgery: a prospective case series. J Anesth Clin Res. 2021;12:999.
Jadon A, Mohsin K, Sahoo RK, Chakraborty S, Sinha N, Bakshi A. Comparison of supra-inguinal fascia iliaca versus pericapsular nerve block for ease of positioning during spinal anaesthesia: a randomised double-blinded trial. Indian J Anaesth. 2021;65:572–8.
Choi YS, Park KK, Lee B, Nam WS, Kim DH. Pericapsular Nerve Group (PENG) block versus supra-inguinal fascia iliaca compartment block for total hip arthroplasty: a randomized clinical trial. J Pers Med. 2022;12:408.
Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66:300–5.
Kim JY, Kim J, Kim DH, Han DW, Kim SH, Kim D, Chung S, Yu S, Lee UY, Park HJ. Anatomical and radiological assessments of injectate spread stratified by the volume of the pericapsular nerve group block. Anesth Analg. 2023;136:597–604.
Kantakam P, Maikong N, Sinthubua A, Mahakkanukrauh P, Tran Q, Leurcharusmee P. Cadaveric investigation of the minimum effective volume for ultrasound-guided suprainguinal fascia iliaca block. Reg Anesth Pain Med. 2021;46:757–62.
Tran J, Agur A, Peng P. Is pericapsular nerve group (PENG) block a true pericapsular block? Reg Anesth Pain Med. 2019;44:257.
Short AJ, Barnett JJG, Gofeld M, Baig E, Lam K, Agur AMR, Peng PWH. Anatomic study of innervation of the anterior hip capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43:186–92.
Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, Vangsness CT Jr. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22:75–81.
Archana BJ, Nagaraj DN, Pradeep P, Lakshmi PS. Anatomical variations of accessory obturator nerve: a cadaveric study with proposed clinical implications. Int J Anat Res. 2016;4:2158–61.
Girón-Arango L, Tran J, Peng PW. Reply to Aydin et al.: A novel indication of pericapsular nerve group block: surgical anesthesia for vein ligation and stripping. J Cardiothorac Vasc Anesth. 2020;34:845–6.
Nielsen TD, Moriggl B, Barckman J, Jensen JM, Kølsen-Petersen JA, Søballe K, Børglum J, Bendtsen TF. Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: a randomised trial. Acta Anaesthesiol Scand. 2019;63:101–10.
Acknowledgements
Authors acknowledge the valuable contribution of Dr. Shweta Puntambekar in sketching Figure 7.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There is no financial or any other conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Diwan, S., Shivamallappa, S., Timane, R. et al. Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers. J Anesth (2024). https://doi.org/10.1007/s00540-024-03333-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00540-024-03333-5