Assessing the Spread of Local Anaesthetic Injection Bupivacaine 0.25 percent(30ml) Using Radiocontrast Dye in Pericapsular Nerve Group (PENG) Block for Hip Surgeries – A Case Series

This is a prospective observational case series designed to evaluate the anatomical spread and clinical efficacy of the Pericapsular Nerve Group (PENG) block in patients undergoing elective hip surgeries. Severe pain in hip fracture patients often makes positioning for subarachnoid block (SAB) difficult. The PENG block is a novel ultrasound-guided regional anaesthesia technique targeting the articular branches of the femoral, obturator, and accessory obturator nerves, potentially providing superior analgesia.

In this study, 10 adult patients, above 18 years, scheduled for hip surgeries under spinal anaesthesia will receive an ultrasound-guided PENG block with 30 ml of 0.25 bupivacaine mixed with iohexol radiocontrast dye (OMNIPAQUE). The injectate spread will be visualised using C-ARM imaging at 5, 10, and 20 minutes after injection.

Primary outcome: Anatomical spread pattern of the injectate as seen on C-ARM imaging and Reduction in pain intensity measured by Visual Analogue Scale (VAS) at baseline, immediately post-block, and at 10, 15, and 20 minutes and Ease of positioning for SAB graded on a 0–3 scale.

The findings will help understand the spread characteristics of the PENG block, optimise block techniques, and provide baseline data for future larger controlled trials.