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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Continuous PENG block in an oncologic patient with bilateral femoral avascular n...
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Vol. 71. Issue 6.
Pages 486-490 (June - July 2024)
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Vol. 71. Issue 6.
Pages 486-490 (June - July 2024)
Case report
Continuous PENG block in an oncologic patient with bilateral femoral avascular necrosis
Bloqueo continuo del grupo de nervios pericapsulares (PENG) en una paciente oncológica con necrosis avascular de la cabeza femoral bilateral
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A. Server
Corresponding author
anna.server@vallhebron.cat

Corresponding author.
, V. Sánchez, E. Schmucker, Á. Mesas, J. Medel
Departamento de Anestesiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Abstract

The PENG block (pericapsular nerve group) is a recently described technique to address the innervation of the hip, one of the most complex anatomical regions to treat at the locoregional level.

We present the case of a patient with acute lymphoblastic leukaemia complicated by avascular necrosis of the bilateral femoral head and previous history of severe chronic pain with probable central sensitization to opioids and a severe thrombocytopenia due to myelotoxicity from chemotherapy treatment.

Given the need for orthopaedic surgery to manage femoral necrosis and in anticipation of complex perioperative pain management, a multimodal strategy was planned including bilateral ultrasound-guided continuous PENG blocks to achieve proper pain control in the perioperative period and promote early recovery. The operation and initial recovery were uneventful and the patient was discharged to the ward within 24 h and started early rehabilitation as planned. The patient had a successful recovery with good functionality.

Keywords:
Regional anesthesia
Bone avascular necrosis
Multimodal treatment
Resumen

El bloqueo PENG (grupo de nervios pericapsulares) es una técnica recientemente descrita para abordar la innervación de la cadera, una de las regiones anatómicas más complejas de tratar a nivel locorregional.

Presentamos el caso de una paciente con leucemia linfoblástica aguda, complicada por necrosis avascular bilateral de la cabeza femoral e historia previa de dolor crónico severo con sensibilización central probable a opioides, y trombocitopenia severa debido a mielotoxicidad por tratamiento de quimioterapia.

Dada la necesidad de cirugía ortopédica para el manejo de la necrosis de cabeza femoral, y como anticipación al manejo complejo del dolor perioperatorio, se planificó una estrategia multimodal incluyendo bloqueos PENG ecoguiados continuos bilaterales para lograr un control del dolor adecuado en el periodo perioperatorio, y promover la recuperación temprana. La operación y recuperación iniciales transcurrieron sin incidencias, y la paciente fue trasladada a planta transcurridas 24 horas, iniciando la rehabilitación temprana, según lo planificado. La paciente tuvo una recuperación exitosa, con buena funcionalidad.

Palabras clave:
Anestesia regional
Necrosis avascular ósea
Tratamiento multimodal

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