Advertisement

Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain

  • Andrés Rocha RomeroEmail author
  • Gabriel Carvajal Valdy
  • Angel Juarez Lemus
Correspondence
  • 16 Downloads

To the Editor,

Cancer pain requires multidisciplinary management, and in most cases sufficient pain relief is possible using systemic multimodal analgesia. Nonetheless, complex cases often require interventional pain management strategies. The pericapsular nerve group (PENG) block is a recently described ultrasound-guided regional anesthesia technique targeting sensitive nerves from the anterior articular capsule of the hip (articular obturator branches, accessory obturator nerve, and articular femoral nerve branches), thus limiting potential mixed nerve block and quadricep or adductor muscle weakness.1

We present an 82-yr-old female diagnosed with a pathological left hip fracture related to metastatic epidermoid carcinoma and associated deep vein thrombosis (DVT). The patient was using apixaban 2.5 mg po bid.She was referred to our pain service because of severe pain on her left hip that was 8/10 on a numeric rating scale limiting all basic activities (she was not able to sit). The...

Notes

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

References

  1. 1.
    Girón-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.Google Scholar
  2. 2.
    Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 1999; 7: 128-33.CrossRefGoogle Scholar
  3. 3.
    Kwun-Tung Ng T, Chan WS, Peng PW, Sham P, Sasaki S, Tsui HF. Chemical hip denervation for inoperable hip fracture. Anesth Analg 2019; DOI:  https://doi.org/10.1213/ane.0000000000004172.
  4. 4.
    Guo S, Lam JW. Ablative techniques. In: Gulati A, Puttaniah V, Bruel BM, Rosenberg WS, Hung JC (Eds). Essentials of Interventional Cancer Pain Management, 1st ed. Springer Nature Switzerland; 2019: 141-3.Google Scholar
  5. 5.
    Yu HC, Moser JJ, Chu AY, Montgomery SH, Brown N, Endersby RV. Inadvertent quadriceps weakness following the pericapsular nerve group (PENG) block. Reg Anesth Pain Med 2019; 44I: 611-3.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Pain ClinicInstituto Nacional de CancerologíaMexicoMexico
  2. 2.Interventional Pain UnitCentro Nacional de Control del Dolor y Cuidados PaliativosSan JoséCosta Rica

Personalised recommendations