Hip (PENG) Block Chapter 20 - NYSORA | NYSORA

Hip (PENG) Block Chapter 20

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A few different approaches have been suggested to perform this block, according to the transducer orientation. Here, we will describe the approach we use at NYSORA’s clinical practice. 

Fig.Transducer positions to perform a hip block A. Transverse oblique B. Saggital C. Saggital oblique.

Transverse oblique (Pericapsular Nerve Group Block/Hip Block)

Transducer position

Place the transducer over the femoral crease in a transverse oblique orientation to image the head of the femur. 

Scanning
  • Slide the transducer cranially until the anterior inferior iliac spine (AIIS), and iliopubic eminence are visualized (pelvic rim).
  • Slide, tilt, and apply pressure to the transducer to improve the view of the hyperechoic surface of the iliopsoas notch, and hyperechoic psoas tendon, between the AIIS and iliopubic eminence. 
    Note: apply only subtle tilting maneuvers.
  • Identify also: The hypoechoic iliopsoas muscle, and femoral artery /nerve superficial to the iliopsoas muscle.

Fig. Hip block; transducer position and sonoanatomy. FA, femoral artery; PE, pectineus muscle; IPE, iliopubic eminence; AIIS, anterior inferior iliac spine.

Needle inserion
  • Insert the needle in-plane from lateral to medial through the iliopsoas muscle toward the plane between the psoas tendon and bone. 
    Note: The needle path should be steep to avoid injury to the femoral nerve/artery.
  • After negative aspiration, inject 10-15 mL of local anesthetic while observing for an adequate spread along the fascial plane.
Tips:
  • The needle position is adjusted when the spread occurs within iliacus muscle, instead of underneath it.
  • If high resistance is perceived while injecting, the needle is slightly withdrawn as it could be obstructed by the periosteum or tendon.
  • Routinely identify the femoral artery and nerve superficial to the iliopsoas muscle to avoid their injury.

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