Idealized Mechanism of the Ping Block (Hip Block)

Introduction

• Purpose: Analgesia following total hip replacement
• Increasingly used for denervation in chronic hip pain
• Focus: Procedure intricacies, scenarios, and critical considerations to avoid complications

Anatomy and Technique

• Target: Articular branches of the femoral nerve
  • Located between periosteum of the pelvic ramus and under the fascia of iliacus muscle
• Procedure: Injection of local anesthetic at the target location

Scenarios for Needle Placement

Scenario A: Ideal Placement

• Needle placed on periosteum
• Optimal spread of local anesthetic
• Effective analgesia without diffusion into iliacus muscle
• Challenges: High resistance during injection

Scenario B: Slight Needle Withdrawal

• Slight withdrawal (1-2 mm) due to resistance
• Local anesthetic spread partially under iliacus muscle fascia and partially into iliacus muscle
• Results in intramuscular injection
• Potential for femoral nerve block

Scenario C: Large Volume Injection

• Overuse of local anesthetic
• Extensive spread within iliacus muscle
• High risk of femoral nerve block due to limited space
• Undesirable outcomes: Muscle weakness

Key Considerations

• Volume control: Maintain around 10 milliliters to preserve femoral nerve and muscle function
• Importance: Precise needle placement and volume control
• Complications: Muscle weakness and risk of femoral nerve block with larger volume

Additional Resources

• Recent publication in Regional Anesthesia and Pain Medicine Journal
• Educational anatomy animations by NYSORA
• Nur's Nerve Block App for mastering techniques
• Nur's YouTube channel for instructional videos

Conclusion

• Importance of learning from real clinical practice
• Encouragement to join the YouTube channel for further learning

Thank you for watching and see you in the next video!