Ultrasound-Guided PENG Block for Analgesia in Early Pregnancy with Femoral Head Fracture and Hip Dislocation: A Case Report
DOI:
https://doi.org/10.24843/3eb6hh34Keywords:
Case Reports, Femoral Fractures, Hip Dislocation, Nerve Block, PregnancyAbstract
Femoral head fracture accompanied by hip dislocation during pregnancy is an uncommon clinical event that presents significant challenges in maternal analgesia and fetal safety. Traumatic hip dislocations account for a small proportion of joint dislocations, while their occurrence during pregnancy is rarely reported, particularly when associated with femoral head fractures. Management becomes more complex because timely reduction and defenitive orthopedic fixation must be achieved while ensuring adequate analgesia and minimizing systemic drug exposure. We describe the case of a 32-year-old woman in early pregnancy (11 weeks of gestation) who presented with a posterior dislocation of the left hip accompanied by a Pipkin type I femoral head fracture following a traffic accident. To provide effective analgesia and reduce fetal risk, a pericapsular nerve group (PENG) block was selected as part of the anesthetic strategy. This regional technique enabled optimal positioning for reduction, minimized the requirement for systemic opioids, and supported early mobilization. Maternal hemodynamics and fetal parameters remained stable throughout the perioperative period. This case highlights the potential role of the PENG block as a focused regional analgesic technique in pregnant trauma patients, particularly during early gestation, where minimizing systemic drug exposure is a critical priority.
Downloads
References
1. Allegaert K, van den Anker JN. Perinatal and neonatal use of analgesic drugs. Arch Dis Child Fetal Neonatal Ed. 2016;101(5):F462–6, doi: 10.1016/j.siny.2017.07.006.
2. Nielsen GL, Sørensen HT, Larsen H, Pedersen L. Risk of adverse birth outcome and miscarriage in pregnant users of NSAIDs. Am J Obstet Gynecol. 2001;184(1):163–9. doi: 10.1136/bmj.322.7281.266
3. Santos AC, Pedersen H. Regional anesthesia for obstetrics. Dalam: Hadzic A, editor. Hadzic’s Textbook of Regional Anesthesia and Acute Pain Management. Edisi ke-2. New York: McGraw-Hill; 2017. hlm. 773–798. ISBN 978-0071741224 / 978-0071717595.
4. Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res. 1973;(92):116–42. doi: 10.1097/00003086-197305000-00011
5. Tomer D, Tupe R, Bartakke G, Bhoi K. Management of Pelvic Fractures and Hip Dislocation in Pregnancy: A Case Report and Review of Literature. J Orthop Case Rep. 2022 Oct;12(10):5-9. DOI: 10.13107/jocr.2022.v12.i10.3342. PMID: 36874880; PMCID: PMC9983384.
6. PIPKIN G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957 Oct;39-A(5):1027-42 passim. PMID: 13475403.
7. Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018 Nov;43(8):859-863. doi: 10.1097/AAP.0000000000000847. PMID: 30063657.
8. Wundiawan KF, Panji PAS, Suranadi W, Widnyana MG, Dewi DAMS, Hartawan IGAGU, et al. Comparison of hemodynamic profiles and onset and offset of motor and sensory blockade between 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine for spinal anesthesia in scheduled cesarean sections: a double-blind, randomized clinical trial. Bali J Anaesthesiol. 2025;9(1):35-41. doi:10.4103/bjoa.bjoa_17_25.
9. Andrade PP, Lombardi RA, Marques IR, Braga ACDNAE, Isaias BRS, Heiser NE. Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol. 2023 Nov-Dec;73(6):794-809. doi: 10.1016/j.bjane.2023.07.007. Epub 2023 Jul 26. PMID: 37507071; PMCID: PMC10625158.
10. Calati P, Lenoir C, Kamel LC, Contie N, Firoloni JD, Sichez A, Sebai A, Chelly J, Caumon L. Effectiveness of pericapsular nerve group block for hip fracture pain management in the emergency department: results of the ED-PENG-B randomised controlled trial. BMC Emerg Med. 2025 Nov 26;25(1):245. doi: 10.1186/s12873-025-01401-x. PMID: 41299315; PMCID: PMC12659107.
11. Horlocker TT, Wedel DJ. Regional anesthesia in the patient receiving antithrombotic and antiplatelet therapy. Reg Anesth Pain Med. 2010;35(1):64–101.s doi: 10.1097/AAP.0b013e3181c15c70
12. Erten E, Kara U, Şimşek F, Eşkin MB, Bilekli AB, Öcal N, Şenkal S, Ozdemirkan İ. Comparison of pericapsular nerve group block and femoral nerve block in spinal anesthesia position analgesia for proximal femoral fractures in geriatric patients: a randomized clinical trial. Ulus Travma Acil Cerrahi Derg. 2023 Dec;29(12):1368-1375. doi: 10.14744/tjtes.2023.33389. PMID: 38073453; PMCID: PMC10767289.
Downloads
Published
Data Availability Statement
Deidentified patient data from this case report/series will be made available upon reasonable request to the corresponding author following publication, subject to institutional data-sharing policies and ethics approval.
Issue
Section
License
Copyright (c) 2026 Made Agus Cahya Nugraha Koriawan, I Gusti Agung Gede Utara Hartawan (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY 4.0) that allows others to share, use, distribute, and reproduce the work in any medium, provided the original author and source are properly credited.
