Written by Dr. Rachel Mirsky (PGY3) and Dr. Nicole Leonard
94 year-old-male with a past medical history of hypertension presents for inability to ambulate after a fall. The patient was walking on the sidewalk one day prior to the day of presentation and tripped on the uneven floor. On exam, he was not in acute distress; his right lower extremity was warm and well perfused, had palpable posterior tibial and dorsalis pedis pulses. His right lower extremity was shortened and externally rotated. He was tender to palpation over the lateral and anterior aspect of his right hip. All compartments were soft and compressible.
X-Ray showed a right femoral neck fracture. He was seen by the orthopedic surgery service and was admitted for surgery for the following day. Throughout his stay in the emergency department the patient remained in pain, so the team decided to perform a PENG block - PEricapsular Nerve Group block. A PENG block is a regional anesthesia technique that targets the anterior hip capsule. With the use of ultrasound (images above), a PENG block was performed with improvement in pain immediately.
Mirsky’s Takeaways:
PENG blocks can benefit patients as their pain levels are decreased. It can also benefit providers and nurses since resources, such as pain medication and time, do not have to be spent on the patient's pain every few hours when IV or oral medications wear off. A PENG block is a relatively safe and quick way to alleviate pain in patients with these ailments. This can lead to increased patient and staff satisfaction.
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