In response to - “Three Blocks including Pericapsular Nerve Block (PENG) for a femoral shaft fracture pain” by Onur Koyuncu et al.

摘要

I read with interest a recently published article in youresteemed journal title ‘‘Three blocks including PericapsularNerve Block (PENG) for a femoral shaft fracture pain’’ byOnur Koyuncu et al.1 I personally congratulate the author forhis innovative and intensive approach to provide analgesia ina case of fracture shaft femur extending up to head of femur.However, I have little reservation for his approach. Firstly,large volume of local anaesthetic was used to give threeblocks which could lead to local anaesthetic toxicity eventhen, the pain control was up to 50% only. This effect couldeasily be attained by increasing the volume of local anaestheticduring PENG block. Various studies have shown thatlarge volume can block femoral, lateral femoral cutaneousnerve and obturator nerve along with assesory obturator andarticular branches of femoral nerves.2---4 Secondly, waitingfor three minutes to assess clinical effect before going forsecond block was quite inadequate. As suggested by authorsof PENG block,5 adequate time should have been given toassess the complete clinical effect.