In response to - “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al.

Dear Editor,

I read with interest a recently published article in your esteemed journal title “Three blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al.¹ I personally congratulate the author for his innovative and intensive approach to provide analgesia in a case of fracture shaft femur extending up to head of femur. However, I have little reservation for his approach. Firstly, large volume of local anaesthetic was used to give three blocks which could lead to local anaesthetic toxicity even then, the pain control was up to 50% only. This effect could easily be attained by increasing the volume of local anaesthetic during PENG block. Various studies have shown that large volume can block femoral, lateral femoral cutaneous nerve and obturator nerve along with assesory obturator and articular branches of femoral nerves.^2-4 Secondly, waiting for three minutes to assess clinical effect before going for second block was quite inadequate. As suggested by authors of PENG block,⁵ adequate time should have been given to assess the complete clinical effect.

References

• ¹
  Koyuncu O, Hakimoglua S, Tugce Polat ST, Kara MY. Three blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain. Rev Bras Anestesiol. 2019;69:638-9.
• ²
  Ahiskalioglu A, Aydin ME, Ahiskalioglu EO, et al. Pericapsular Nerve Group (PENG) block for surgical anesthesia of medial thigh. J Clin Anesth. 2019;59:42-3.
• ³
  Aydin ME, Borulu F, Ates I, Kara S, Ahiskalioglu A. A novel indication of Pericapsular Nerve Group (PENG) block: surgical anesthesia for vein ligation and stripping. J Cardiothorac Vasc Anesth. 2019;34:843-5.
• ⁴
  Ahiskalioglu A, Aydin ME, Ozkaya F, Ahiskalioglu EO, Adanur S. A novel indication of Pericapsular Nerve Group (PENG) block: prevention of adductor muscle spasm. J Clin Anesth. 2019;60:51-2.
• ⁵
  Girón-Arango L, Peng PW, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43:859-63.

Publication Dates

• Publication in this collection
  21 Sept 2020
• Date of issue
  Jul-Aug 2020

History

• Received
  30 Mar 2020