Surgeon-Performed Intraoperative Pericapsular Nerve Group Block in Total Hip Replacement: A Cadaveric Feasibility Study.

Introduction: The pericapsular nerve group (PENG) block is an emerging technique for perioperative analgesia in hip surgery, offering effective pain control while preserving motor function. Its use has been associated with reduced opioid consumption and improved early mobilization compared to conventional blocks. Despite these advantages, practical implementation of the technique remains variable across surgical settings. This study explores the anatomical feasibility of performing the PENG block intraoperatively by the surgeon, providing a potential alternative delivery route integrated within the surgical procedure. Materials and Methods: A cadaveric feasibility study was conducted on a fresh-frozen right lower limb from an 83-year-old male. An ultrasound-guided PENG block was first performed by an anesthesiologist using standard technique. Subsequently, a surgeon placed a second needle through a posterolateral approach under direct visualization of the anterior hip capsule. Needle positions were compared through surgical exposure through a Hueter-type anterior approach. Results: Both needles were located in the same myofascial plane between the iliopsoas tendon and pubic ramus, with the intraoperative needle positioned <1 cm proximal to the ultrasound-guided one. No neurovascular structures were compromised. Conclusion: This cadaveric study demonstrates that intraoperative surgeon-performed PENG block placement through a posterior approach is anatomically feasible and accurately replicates the needle position of the conventional ultrasound-guided technique. These findings support the anatomical validity of this approach; however, further in vivo studies are required to evaluate its clinical efficacy and safety.