REPLY TO COMMENTS Year : 2021  |  Volume : 65  |  Issue : 7  |  Page : 565  

In response to, PENG block: Advantages of out-of-plane approach

Ashok Jadon, Neelam Sinha, Swastika Chakraborty, Bhupendra Singh
Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Jamshedpur, Jharkhand, India

Date of Submission07-May-2021Date of Decision10-May-2021Date of Acceptance20-May-2021Date of Web Publication23-Jul-2021

Correspondence Address:
Ashok Jadon
Duplex-63, Vijaya Heritage Phase-6, Kadma, Jamshedpur - 831 005, Jharkhand
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ija.IJA_400_21

How to cite this article:
Jadon A, Sinha N, Chakraborty S, Singh B. In response to, PENG block: Advantages of out-of-plane approach. Indian J Anaesth 2021;65:565
How to cite this URL:
Jadon A, Sinha N, Chakraborty S, Singh B. In response to, PENG block: Advantages of out-of-plane approach. Indian J Anaesth [serial online] 2021 [cited 2021 Jul 23];65:565. Available from: https://www.ijaweb.org/text.asp?2021/65/7/565/322187

Sir,

We thank the readers for their interest in our recent publication and also supporting our point of view that, out-of-plane (OOP) approach is a feasible alternative and it will further enhance the utility of pericapsular nerve group (PENG) block.[1],[2]

We fully agree with the suggestion that experience of the performer is the pre-requisite for safe conduct of any approach of PENG block. We also agree with the concerns raised by the authors about possible risks during in-plane approach of PENG block, suggestions to avoid them and the use of OOP approach as an alternative.[3] To further improve the safety profile of OOP approach, we strongly recommend that blunt tip nerve stimulating block needle attached with nerve stimulator should be used to avoid any inadvertent femoral nerve injury.[4]

As far as catheter insertion in OOP approach is concerned, we have limited experience. However, once hydro-dissection is done with saline and bevel is directed medially, we did not find any difficulty in successful catheter insertion in first attempt in two of our patients (unpublished data) [Figure 1].

Figure 1: Out-of-plane PENG block sonographic image shows catheter insertion through Tuohy needle. *hydro-dissection with saline, FA-femoral artery, FN-femoral nerve, SPR-superior pubic ramus

Click here to view

Last but not the least, the use of ultrasound is ideal for safe conduct of PENG block by any approach. However, OOP approach can also be used with the help of nerve stimulator and landmark-based technique in low resource settings where ultrasound is not available.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Lopez-Lopez D, Reza PC, Vazquez MG, Garcia PD. PENG block: Advantages of out-of-plane approach. Indian J Anaesth 2021;65:563-4.  
  [Full text]  2.Jadon A, Sinha N, Chakraborty S, Singh B, Agrawal A. Pericapsular nerve group (PENG) block: A feasibility study of landmark based technique. Indian J Anaesth 2020;64:710-13.  
  [Full text]  3.Jadon A, Sinha N, Singh B, Agrawal A. Out-of-plane approach to prevent injury to lateral femoral cutaneous nerve (LFCN) in pericapsular nerve group (PENG) block. SF J Radiol Clin Diagn 2020;2:1003.  
    4.Jadon A, Sinha N, Chakraborty S, Ahmad A. An out-of-plane approach for pericapsular nerve group block: A case series. Bali J Anaesthesiol 2020;4:S67-70.  
    
  [Figure 1]