welcome back to nur's YouTube channel in today's video we are going to discuss the idealized mechanism of the Ping block or hip block primarily used for analgesia following total Hep replacement now the pink block or pericapsular nerve group block technique is also increasingly being utilized for denervation in patients suffering from chronic hip pain we will discuss the intricacies of the procedure common scenarios and the critical considerations to avoid complication s the essence of the Pang block technique lies in its ability to anesthetize the articular branches of the fem nerve these branches are situated between the periosteum of the pelvic ramus and underneath the fascia of the liakas muscle to achieve effective analgesia a local anesthetic is injected precisely at this location in the ideal scenario refer to scenario a the needle is accurately placed on a periosteum allowing for an optimal spread of the local anesthetic the placement ensures that the anesthetic effectively reaches the articular branches of the fal nerve without defusing into the unintended area meaning the IL Aquis muscle however achieving this perfect placement can be challenging due to the resistance that is encountered during the injection process with the needle on the periost in many cases injecting directly on the periosteum is not feasible due to the high resistance a when the needle is rotated to overcome this a very slight needle withdrawal typically about 1 or 2 mm is necessary this adjustment leads us to scenario B where the local anesthetic May partially spread underneath the fascia of the liakas muscle and partially into the lower portion of the liis muscle itself this results in an intram mascular injection which is still effective but it could lead to emal Nur block it is essential to keep the volume of the local anesthetic to around 10 milliliters doing so preserves the fal nerve and CPS muscle function ensure an effective analgesia without significant muscle weakness however increase in the volume of the local anesthetic can lead to undesirable outcomes when a larger volume of local anesthetic is used scenario C can easily occur in this case the spread within the IL Aquis muscle becomes ensive reaching the femal nerve this is problematic because the space between the periostium and the posterior fcia of the elais muscle is limited in its capacity consequently large volumes of the injectate are likely to escape into the muscle increasing the risk of a femal nerve block understanding these scenarios and the anatomy involved is crucial for performing The Ping or hip block effectively a recent publication in the regional anesthesia pain medicine Journal provides further insights into these findings and underscores the importance of precise needle placement and volume control during this procedure these reverse alround Anatomy animations from nysora are uniquely educational offering and parallel insights into Regional anesthesia techniques to further enhance your learning experience we encourage you to access these resources through nur's renowned nerve black app this app is an valuable tool for mastering various neblock techniques and additionally be sure to become a member of our YouTube channel where you can watch a growing number of Highly instructional videos from nur's clinical practice this is one of the best ways to learn Regional anesthesia techniques from the pros without committing to a 12month fellowship thank you for watching and see you in the next video