Combination of Pericapsular Nerve Group (PENG) and Sacral Plexus Blocks for Minimally Invasive Percutaneous Internal Fixation in Outpatient with Femoral Neck Pathologic Fracture

Dear Editor, Minimally invasive percutaneous internal fixation for malignant pathological fracture is one of the most common outpatient surgeries in Shanghai Sixth People's Hospital, playing an important role in the palliative therapy of bone metastases in the lower extremities. This surgical procedure is always performed under spinal or general anesthesia. However, malignant tumors are usually associated with spinal metastases and cardiopulmonary complications, increasing the risk of spinal and general anesthesia, which leads to a failure to meet the requirements of rapid recovery in outpatient surgery. The nerves supplying the lower limbs primarily originate from the lumbosacral plexus. The pericapsular nerve group (PENG) block is a novel regional analgesia technique to block hip articular ramification from femoral and obturator nerves, and it has an advantage of no motor block [1]. Ahiskalioglu et al. [2] considered a high-volume PENG block could block the lumber plexus. We here report the successful use of a PENG block combined with a sacral plexus block for outpatient anesthesia in patients with femoral neck pathologic fracture undergoing minimally invasive percutaneous internal fixation. The lack of requirement for opioids or special postures and the rapid motor recovery of the lower limbs made this anesthetic technique more suitable for outpatient anesthesia of hip surgery.