An unusual Intraosseous diffusion after a PENG block: A Cadaver Study

An unusual Intraosseous diffusion after a PENG block: A Cadaver Study

PENG block is routinely implemented as a part of multi-modal analgesia for hip surgical procedures. However, a recent cadaver dissection suggest it is not a true pericapsular block. We in 2 cadavers executed cross-sections after PENG injection with methylene blue dye.

In 2 fresh (4 sides) cadavers (76 and 86 years), ultrasound guided PENG block (0 mL 0.1% methylene blue dye) was administered with linear probe (sonosite 3-12mHz) in real time. The cadavers were cross-sectioned at the level of ASIS and below the inguinal ligament. The spread of the dye was noted.

In 4 specimens, the spread of dye was noted in following areas table1. Intra-osseous spread was noted in 2 specimens. Fig1 In all specimens the dye was dorsal and lateral to iliacus muscle.

Cross-sections reveal a more deeper tissue plane diffusion. In our study, the intra-osseous identification in 2 specimens was a revelation. To our knowledge, this is the first occasion where dye spread from an inter-fascial plane is recognized inside the marrow. We recommend applying colour mode for PENG injection to be scrutinize abnormal vasculature.