Maverick Modules (23-26) PENG, LFCB, PSB, & Post-Op

Question 1

What are indications for a PENG (Pericapsular Nerve Group) block?

Answer 1

Anything involving Hip Joint & Femoral Neck

• Hip arthroscopy
• Total Hip Replacement
• Femoral Neck Fracture

Question 2

What are the advantages of a PENG block?

Answer 2

• ↓ Opioids
• ↓ MAC (especially good for elderly)

Question 3

PENG block can be combined with ___________ block to provide complete analgesia for many hip procedures.

Answer 3

LFCN (Lateral Femoral Cutaneous Nerve)

Question 4

What makes PENG blocks superior to Fascia Iliaca (FICB) and Lumbar Plexus (LP) blocks?

Answer 4

PENG will reliably anesthetize obturator nerve branches that are missed by FICB and LPB’s.

Question 5

What are the contraindications for PENG block?

Answer 5

• Patient Refusal
• Infection at site
• LA allergy
• Severe Bleeding Disorder

Question 6

What does AIIS stand for in the picture below?
What does the red line indicate?

Answer 6

• Anterior Inferior Iliac Spine
• Field of LA spread

Question 7

What nerve (and origins) are noted by the green line below?

Answer 7

Obturator Nerve (L2-L4)

Question 8

What nerve (and origins) are noted by the blue line below?

Answer 8

Accessory Obturator Nerve (L3-L4)

Question 9

What nerve (and origins) are noted by the yellow line below?

Answer 9

Femoral Nerve (L2-L4)

Question 10

When performing a PENG block, the ultrasound probe should be parallel to the _____ ______.

Answer 10

Inguinal Crease

Question 11

What dose of LA is necessary for post-op pain control with a PENG block?
What dose would be necessary for surgical analgesia?

Answer 11

Question 12

Failure to capture ________________ nerve may be interpreted as a failed PENG block. (Though it is not)

Answer 12

Lateral Femoral Cutaneous Nerve

Question 13

What are indications for LCFN (Lateral Cutaneous Femoral Nerve) Block?

Answer 13

• Surgical Incision on lateral thigh
• Adjunct to other blocks (Typically PENG)

Question 14

Where is the LFCN in relation to the sartorius?

Answer 14

About 1cm superficial to the sartorius

Question 15

How much volume of LA is necessary for an LFCN block?

Answer 15

5 - 10 mL

Question 16

How deep is the LFCN likely to be?

Answer 16

1 - 1.5 cm

Question 17

What are the two bifurcations of the sciatic nerve?

Answer 17

• Tibial nerve
• Common Peroneal nerve

Question 18

What is the most desirable motor response elicited from a popliteal sciatic nerve block?

Answer 18

Inversion (indicates stimulation of both tibial and deep peroneal)

Question 19

Tibial nerve stimulation elicits what motor response?

Answer 19

Plantarflexion

Question 20

Common Peroneal nerve stimulation elicits what response?

Answer 20

Dorsiflexion/Eversion