Perioperative Analgesia with Combined Pericapsular Nerve Group (PENG) and Lateral Femoral Cutaneous Nerve Blocks in Pediatric Femoral Neck Surgery: A Two-Case Report

Perioperative Analgesia with Combined Pericapsular Nerve Group (PENG) and Lateral Femoral Cutaneous Nerve Blocks in Pediatric Femoral Neck Surgery: A Two-Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Perioperative Analgesia with Combined Pericapsular Nerve Group (PENG) and Lateral Femoral Cutaneous Nerve Blocks in Pediatric Femoral Neck Surgery: A Two-Case Report OZGE PEKSEN KIZILIŞIK, HALIL KIZILISIK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9058049/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background The importance of regional anesthesia techniques is increasing as part of multimodal analgesia strategies for managing postoperative pain in pediatric hip and femur surgeries. Case Presentation: We aim to present two cases, aged 10 years and 18 months, scheduled for surgery due to femoral neck fractures. As part of multimodal pain management, ultrasound-guided PENG + LFCN blocks were performed in both cases. Postoperative pain was assessed using VAS and FLACC scales. Conclusions We advocate the use of these techniques in combination in the pediatric population, as they facilitate pain management and reduce opioid requirements. However, larger-scale studies are needed to provide more concrete evidence regarding their true risks and benefits. Pediatric anesthesia Pericapsular nerve group block Lateral femoral cutaneous nerve block Femoral neck surgery Regional anesthesia Opioid-sparing analgesia Figures Figure 1 Figure 2 Background Postoperative pain is significant in pediatric hip and femur surgeries, as it is frequently of moderate to severe intensity( 1 , 2 ). Because opioids are commonly preferred for the management of this pain, side effects such as nausea, vomiting, sedation, and respiratory depression may occur, potentially adversely affecting the recovery process( 1 , 2 , 3 ). Therefore, the importance of multimodal analgesia—and consequently regional anesthesia techniques—has increased in pediatric anesthesia to reduce opioid use. The Pericapsular Nerve Group (PENG) block is an ultrasound-guided regional anesthesia technique that targets the articular branches of the femoral nerve (FN), obturator nerve (ON), and accessory obturator nerve (AON), which innervate the anterior capsule of the hip joint. It was first described by Rafael Girón-Arango and colleagues in 2018 to provide analgesia in patients with hip fractures ( 1 , 4 , 5 ). While selectively blocking the nerves responsible for the sensory innervation of the hip, it preserves motor function because it does not affect the main trunks of the femoral and obturator nerves. Compared with femoral nerve blocks, its major advantages include enabling early postoperative mobilization and allowing earlier and easier neurological assessment. These benefits positively influence the rehabilitation process, particularly in pediatric patients in whom early mobilization is important ( 2 , 3 ). Although the PENG block provides effective analgesia for the hip capsule, it does not cover the anterolateral aspect of the thigh where surgical incisions are commonly located. Therefore, it can be combined with a lateral femoral cutaneous nerve (LFCN) block, which provides analgesia to this region, resulting in more comprehensive analgesia for the hip area ( 1 – 4 , 6 ). In this report, we aimed to present two pediatric cases who underwent surgery for femoral neck fractures. Ethical approval was not required due to the nature of the report, and written informed consent was obtained from the parents for the procedures, clinical details, and photographs. Case 1 A 10-year-old, 25-kg male patient scheduled for femoral nailing due to a femoral neck fracture was included. After obtaining written informed consent from the family, standard anesthesia monitoring was applied, and anesthesia was induced with 2.5 mg/kg propofol, 1 µg/kg fentanyl, and 0.8 mg/kg rocuronium. After ensuring aseptic conditions, the tendon of the iliopsoas muscle and the lateral femoral cutaneous nerve were identified adjacent to the inguinal ligament using a linear ultrasound (US) probe (Figs. 1 and 2 ). Preoperatively, PENG and LFCN blocks were performed. Under ultrasound guidance, the needle was visualized beneath the iliopsoas tendon, and 0.25% bupivacaine was infiltrated at a dose of 0.5 mL/kg. In the same plane, the needle was withdrawn and 0.25% bupivacaine was infiltrated at 0.3 mL/kg into the adipose tissue surrounding the lateral femoral cutaneous nerve (Table 1 ). The patient’s surgery lasted 2 hours and 50 minutes. During the operation, anesthesia was maintained with 1 MAC sevoflurane and remifentanil infusion at 0.05–0.25 µg/kg/min, titrated according to hemodynamic response, with a total remifentanil consumption of 500 µg. At the end of the procedure, 600 mg of acetaminophen was administered for multimodal analgesia. An intravenous fentanyl patient-controlled analgesia (PCA) device was prepared according to the patient’s body weight (PCA settings: 10 µg loading dose, 5 µg bolus, 8–10 min lockout). Postoperatively, the patient was monitored for 42 hours. The Visual Analog Scale (VAS) scores were 0 at postoperative hours 1, 2, 6, and 12, increasing to 5 at 24 hours (Table 2 ). Apart from acetaminophen administered three times daily, the patient received a total of three PCA boluses (two within the first 24 hours), consuming 25 µg of fentanyl. At 42 hours postoperatively, the patient was pain-free and, with surgical clearance, was discharged with appropriate recommendations. Case 2 An 18-month-old male patient weighing 10 kg had previously undergone closed reduction and internal fixation for a traumatic femoral neck fracture and was scheduled for removal of the fixation devices. After obtaining written informed consent from the family, standard hemodynamic monitoring was applied. Nasal oxygen supplementation was provided at 2 L/min. Sedoanalgesia was administered with 0.1 mg/kg midazolam and 1 mg/kg ketamine, appropriate for the surgical procedure. After ensuring aseptic conditions under ultrasound guidance, the inguinal region was scanned. Following identification of the anterior inferior iliac spine, the probe was rotated in a cranio-caudal direction, allowing the femoral artery, vein, nerve, iliopsoas tendon, and lateral femoral cutaneous nerve to be visualized in the same plane. To avoid multiple needle insertions and minimize the risk of vascular injury, PENG and LFCN blocks were performed with a single needle insertion under ultrasound guidance. First, 0.5 mL/kg of 0.25% bupivacaine was injected beneath the iliopsoas tendon over the iliopubic eminence. Subsequently, without reinserting the needle, it was withdrawn and the lateral femoral cutaneous nerve was visualized near the rectus muscle, where 0.3 mL/kg of 0.25% bupivacaine was injected (Table 1 ). The surgical procedure lasted 30 minutes, and no additional perioperative analgesic was required. In the postoperative period, the patient remained comfortable, with pain assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, showing scores ranging from 0 to 2 during the first 12 hours, and only scheduled paracetamol was administered for analgesia. (Table 3 ). No block-related complications or motor weakness were observed, and the patient was discharged with recommendations at postoperative hour 12 on the following day. Table 1 Clinical and Perioperative Characteristics of the Cases Parameter Case 1 Case 2 Sex Male Male Age 10 years 18 months Weight 25 kg 10 kg ASA Physical Status I I Comorbidity None None Type of Surgery Femoral fracture / Intramedullary nailing Femoral fracture / Implant removal Duration of Surgery 2 h 50 min 30 min Type of Anesthesia General anesthesia + PENG + LFCN block Sedoanalgesia + PENG + LFCN block Local Anesthetic Type and Dose PENG: 0.5 mL/kg of 0.25% bupivacaine LFCN: 0.3 mL/kg of 0.25% bupivacaine PENG: 0.5 mL/kg of 0.25% bupivacaine LFCN: 0.3 mL/kg of 0.25% bupivacaine Table 2 Case 1 VAS Scale Hour 1st 2nd 3rd 4th 5th 6th 12th 24th 48th VAS 0 0 0 0 0 0 0 5 discharged Table 3 Case 2 FLACC Scale Hour 1st 2nd 3rd 4th 5th 6th 12th 24th 48th FLACC 0 0 0 0 0 0 2 discharged Discussion and Conclusion Although the PENG block is well established in the adult literature, evidence supporting its use in the pediatric population remains limited. Most existing reports have focused on school-aged children ( 1 , 2 , 4 ). Data on the combined use of PENG and LFCN blocks in children under five years of age—as exemplified by Case 2 (18 months old)—are particularly scarce ( 3 ). Sonoanatomic studies in young children have demonstrated that the femoral nerve lies in close proximity to the target site (iliopsoas notch), indicating that local anesthetic dosing (mg/kg) must be carefully titrated ( 2 ). Aksu et al. have described performing both blocks through a single needle insertion ( 7 ). Our cases extend this approach to the pediatric population. No complications or signs of local anesthetic toxicity were observed with the doses used in our patients. Beltramini et al. reported that VAS can be used for pain assessment in pediatric patients aged six years and older ( 8 ). Reports also recommend the FLACC scale for evaluating postoperative pain in children between two months and seven years of age ( 9 ). In our study, VAS was used to assess pain in the first case, whereas FLACC was employed for the second case, who was 18 months old. Roy et al., in their published case series, reported that the combined use of PENG and LFCN blocks may provide more effective analgesia in hip surgery ( 10 ). In our pediatric femoral fracture cases, the use of PENG + LFCN blocks was associated with a reduction or elimination of opioid requirements, which is consistent with the existing literature. For example, Orozko et al. reported an 8-year-old case in which the PENG + LFCN combination provided adequate analgesia, with no need for any analgesics or opioids during the first 72 hours postoperatively ( 11 ). Similarly, Domagalska et al. emphasized that the PENG block enabled opioid-free pain management in children aged 2 and 4 years ( 12 ). Other reports in the literature also indicate that the PENG block significantly reduces opioid consumption. In a series presented by Bunnel et al., one of three pediatric cases required no opioids, while in the remaining two cases, the first opioid requirement occurred relatively late, between 12 and 17 hours postoperatively ( 4 ). Consistent with the literature, analgesia was effective in both patients, opioid use was minimal or absent, motor function was preserved, and no adverse effects were observed. The feasibility of this technique in an 18-month-old child is particularly noteworthy given the limited literature in this age group. Additionally, the single-needle approach may reduce the invasiveness of the procedure and the risk of complications. In summary, the combined use of PENG and LFCN blocks appears to be a safe and effective strategy for perioperative analgesia in pediatric femoral neck surgery. These cases highlight the potential of this technique to reduce opioid requirements and enhance postoperative comfort in children. They also aim to contribute toward establishing a new standard for pediatric regional anesthesia practice. Declarations Phone number +905439406027 Declarations Ethics approval and consent to participate Ethical approval was not required due to the nature of this case report. Consent for publication Written informed consent was obtained from the patients’ parents for publication of clinical details and images. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Author Contribution OPK wrote the main manuscript text, prepared figures, tableHK wrote the main manuscript text, prepared figuresAll authors reviewed the manuscript Acknowledgements Not applicable. Data Availability All relevant data are included within the article. References Elhamrawy A, Kerbage J, Veneziano G, Martin DP, Tobias JD. Pericapsular Nerve Group (PENG) Block in Pediatric Patients Undergoing Hip and Pelvic Surgical Procedures: An Educational Focused Review. J Pain Res. 2024;17:3697–705. 10.2147/JPR.S481273 . Gurbuz H, Colak T. Evaluation of inguinal sonoanatomy regarding pericapsular nerve group (PENG) block in children: the relation of femoral artery, femoral nerve, lateral femoral cutaneous nerve and iliopsoas notch. BMC Anesthesiol. 2025;25:144. 10.1186/s12871-025-03020-2 . Ahmadzadeh S, Schwab HM, O'Dell Duplechin M, Broocks KM, Hirsch JD, Drinkard J, Shekoohi S. Comparison of Pericapsular Nerve Group Block and Lumbar Epidural Block for Pain Management After Hip Surgery, Focusing on Pediatric Patients: A Narrative Review. Neurol Int. 2025;17:142. 10.3390/neurolint17090142 . Bunnell AM, Smith JV. Pericapsular Nerve Group (PENG) Block for Pediatric Hip Surgery: A Report of Three Cases. Cureus. 2025;17:e78996. 10.7759/cureus.78996 . Girón-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018;43:859–63. 10.1097/AAP.0000000000000847 . Vetrone F, Saglietti F, Galimberti A, Pezzi A, Umbrello M, Cuttone G, et al. Pericapsular Nerve Group Block Plus Lateral Femoral Cutaneous Nerve Block vs. Fascia Iliaca Compartment Block in Hip Replacement Surgery. J Clin Med. 2025;14:984. 10.3390/jcm14030984 . Aksu C, Cesur S, Kuş A. Pericapsular nerve group block and lateral femoral cutaneous block with single needle entry are possible in pediatric patients. J Clin Anesth. 2021;71:110215. 10.1016/j.jclinane.2021.110215 . Beltramini A, Milojevic K, Pateron D. Pain Assessment in Newborns, Infants, and Children. Pediatr Ann. 2017;46:e387–95. 10.3928/19382359-20170921-03 . Trottier ED, Ali S, Doré-Bergeron M-J, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health. 2022;27:429–37. 10.1093/pch/pxac048 . Roy R, Agarwal G, Pradhan C, Kuanar D. Total postoperative analgesia for hip surgeries: PENG block with LFCN block. Reg Anesth Pain Med. 2019. 10.1136/rapm-2019-100454 . Orozco S, Muñoz D, Jaramillo S, Herrera AM. Pediatric use of Pericapsular Nerve Group (PENG) block for hip surgical procedures. J Clin Anesth. 2019;57:143–4. 10.1016/j.jclinane.2019.04.010 . Domagalska M, Wieczorowska-Tobis K, Reysner T, Geisler-Wojciechowska A, Grochowicka M, Kowalski G. Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report. J Pers Med. 2023;13:454. 10.3390/jpm13030454 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9058049","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":609945930,"identity":"d179e66d-b810-4791-846e-52e5bdfb71ec","order_by":0,"name":"OZGE PEKSEN KIZILIŞIK","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYBADAyBmfAAkZNh4SNDCDCJ4YFokiNHCBlLFw0BICz//8YsPGHfYGMu39x6r/FFTy8PHc4D5xcc2hjrzBuxaJBvOFBswnkkzMzhzLu02z7HjPGy8DWyWM9sYJGQO4HDQwZ40Cca2wzYGEjlmtxnYjvGw8TOwGfOcYZDA5TKDwzzpPxjb/tvIz39jVvjjHzFajrEfY2BsO2DGcIPHjIG3rQbkMObHPBW4tUj28DBLJJ5JNjY4k2Mszdt3ABjIB9sYZ1RISM7AHWIPP3zcYWc4v/2M4ccf3+rk5HuSD3/4YGDDjztieAwYEhvgvMNAzNgmgT8m2R8wMCK01IEI5g941I+CUTAKRsHIAwCWhlCfDpnjjAAAAABJRU5ErkJggg==","orcid":"","institution":"KOŞUYOLU HIGH SPECIALIZATION TRAINING AND RESEARCH HOSPITAL","correspondingAuthor":true,"prefix":"","firstName":"OZGE","middleName":"PEKSEN","lastName":"KIZILIŞIK","suffix":""},{"id":609945933,"identity":"3f0c27c3-64bd-4e4b-9e18-6d3d3629e982","order_by":1,"name":"HALIL KIZILISIK","email":"","orcid":"","institution":"SANCAKTEPE MARTYR PROF. DR. İLHAN VARANK EDUCATION AND RESEARCH HOSPITAL","correspondingAuthor":false,"prefix":"","firstName":"HALIL","middleName":"","lastName":"KIZILISIK","suffix":""}],"badges":[],"createdAt":"2026-03-07 11:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9058049/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9058049/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105259584,"identity":"8a46c64b-de8c-431e-b709-b693d61bbf64","added_by":"auto","created_at":"2026-03-24 05:51:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151476,"visible":true,"origin":"","legend":"\u003cp\u003ePericapsular nerve group (PENG) block\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9058049/v1/3e9949f59e0b159a4b6a22ed.png"},{"id":105259583,"identity":"318249fa-924f-42de-ae6b-0d09f3d8b1a0","added_by":"auto","created_at":"2026-03-24 05:51:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":219196,"visible":true,"origin":"","legend":"\u003cp\u003eLateral Femoral Cutaneous Nerve (LFCN) block\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9058049/v1/77ceb995df37d10a9a135556.png"},{"id":105259585,"identity":"c93f1b72-4a43-40c9-9e9c-1c2cd8015bac","added_by":"auto","created_at":"2026-03-24 05:52:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":805702,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9058049/v1/182d8de8-c702-4a32-b839-be72b1afbc15.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perioperative Analgesia with Combined Pericapsular Nerve Group (PENG) and Lateral Femoral Cutaneous Nerve Blocks in Pediatric Femoral Neck Surgery: A Two-Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003ePostoperative pain is significant in pediatric hip and femur surgeries, as it is frequently of moderate to severe intensity(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Because opioids are commonly preferred for the management of this pain, side effects such as nausea, vomiting, sedation, and respiratory depression may occur, potentially adversely affecting the recovery process(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Therefore, the importance of multimodal analgesia\u0026mdash;and consequently regional anesthesia techniques\u0026mdash;has increased in pediatric anesthesia to reduce opioid use.\u003c/p\u003e \u003cp\u003eThe Pericapsular Nerve Group (PENG) block is an ultrasound-guided regional anesthesia technique that targets the articular branches of the femoral nerve (FN), obturator nerve (ON), and accessory obturator nerve (AON), which innervate the anterior capsule of the hip joint. It was first described by Rafael Gir\u0026oacute;n-Arango and colleagues in 2018 to provide analgesia in patients with hip fractures (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). While selectively blocking the nerves responsible for the sensory innervation of the hip, it preserves motor function because it does not affect the main trunks of the femoral and obturator nerves. Compared with femoral nerve blocks, its major advantages include enabling early postoperative mobilization and allowing earlier and easier neurological assessment. These benefits positively influence the rehabilitation process, particularly in pediatric patients in whom early mobilization is important (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the PENG block provides effective analgesia for the hip capsule, it does not cover the anterolateral aspect of the thigh where surgical incisions are commonly located. Therefore, it can be combined with a lateral femoral cutaneous nerve (LFCN) block, which provides analgesia to this region, resulting in more comprehensive analgesia for the hip area (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this report, we aimed to present two pediatric cases who underwent surgery for femoral neck fractures.\u003c/p\u003e \u003cp\u003eEthical approval was not required due to the nature of the report, and written informed consent was obtained from the parents for the procedures, clinical details, and photographs.\u003c/p\u003e \u003c/p\u003e"},{"header":"Case 1","content":"\u003cp\u003eA 10-year-old, 25-kg male patient scheduled for femoral nailing due to a femoral neck fracture was included. After obtaining written informed consent from the family, standard anesthesia monitoring was applied, and anesthesia was induced with 2.5 mg/kg propofol, 1 µg/kg fentanyl, and 0.8 mg/kg rocuronium. After ensuring aseptic conditions, the tendon of the iliopsoas muscle and the lateral femoral cutaneous nerve were identified adjacent to the inguinal ligament using a linear ultrasound (US) probe (Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Preoperatively, PENG and LFCN blocks were performed. Under ultrasound guidance, the needle was visualized beneath the iliopsoas tendon, and 0.25% bupivacaine was infiltrated at a dose of 0.5 mL/kg. In the same plane, the needle was withdrawn and 0.25% bupivacaine was infiltrated at 0.3 mL/kg into the adipose tissue surrounding the lateral femoral cutaneous nerve (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The patient’s surgery lasted 2 hours and 50 minutes. During the operation, anesthesia was maintained with 1 MAC sevoflurane and remifentanil infusion at 0.05–0.25 µg/kg/min, titrated according to hemodynamic response, with a total remifentanil consumption of 500 µg. At the end of the procedure, 600 mg of acetaminophen was administered for multimodal analgesia. An intravenous fentanyl patient-controlled analgesia (PCA) device was prepared according to the patient’s body weight (PCA settings: 10 µg loading dose, 5 µg bolus, 8–10 min lockout). Postoperatively, the patient was monitored for 42 hours. The Visual Analog Scale (VAS) scores were 0 at postoperative hours 1, 2, 6, and 12, increasing to 5 at 24 hours (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Apart from acetaminophen administered three times daily, the patient received a total of three PCA boluses (two within the first 24 hours), consuming 25 µg of fentanyl. At 42 hours postoperatively, the patient was pain-free and, with surgical clearance, was discharged with appropriate recommendations.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Case 2","content":"\u003cp\u003eAn 18-month-old male patient weighing 10 kg had previously undergone closed reduction and internal fixation for a traumatic femoral neck fracture and was scheduled for removal of the fixation devices. After obtaining written informed consent from the family, standard hemodynamic monitoring was applied. Nasal oxygen supplementation was provided at 2 L/min. Sedoanalgesia was administered with 0.1 mg/kg midazolam and 1 mg/kg ketamine, appropriate for the surgical procedure. After ensuring aseptic conditions under ultrasound guidance, the inguinal region was scanned. Following identification of the anterior inferior iliac spine, the probe was rotated in a cranio-caudal direction, allowing the femoral artery, vein, nerve, iliopsoas tendon, and lateral femoral cutaneous nerve to be visualized in the same plane. To avoid multiple needle insertions and minimize the risk of vascular injury, PENG and LFCN blocks were performed with a single needle insertion under ultrasound guidance. First, 0.5 mL/kg of 0.25% bupivacaine was injected beneath the iliopsoas tendon over the iliopubic eminence. Subsequently, without reinserting the needle, it was withdrawn and the lateral femoral cutaneous nerve was visualized near the rectus muscle, where 0.3 mL/kg of 0.25% bupivacaine was injected (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The surgical procedure lasted 30 minutes, and no additional perioperative analgesic was required. In the postoperative period, the patient remained comfortable, with pain assessed using the \u003cem\u003eFace, Legs, Activity, Cry, Consolability\u003c/em\u003e (FLACC) scale, showing scores ranging from 0 to 2 during the first 12 hours, and only scheduled paracetamol was administered for analgesia. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). No block-related complications or motor weakness were observed, and the patient was discharged with recommendations at postoperative hour 12 on the following day.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and Perioperative Characteristics of the Cases\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCase 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCase 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e18 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e25 kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10 kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eASA Physical Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eType of Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFemoral fracture / Intramedullary nailing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFemoral fracture / Implant removal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDuration of Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2 h 50 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e30 min\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eType of Anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGeneral anesthesia + PENG + LFCN block\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSedoanalgesia + PENG + LFCN block\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLocal Anesthetic Type and Dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePENG: 0.5 mL/kg of 0.25% bupivacaine \u003c/p\u003e \u003cp\u003eLFCN: 0.3 mL/kg of 0.25% bupivacaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePENG: 0.5 mL/kg of 0.25% bupivacaine \u003c/p\u003e \u003cp\u003eLFCN: 0.3 mL/kg of 0.25% bupivacaine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCase 1 VAS Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eHour\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e1st\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e2nd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e3rd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e4th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e5th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e6th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e12th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e24th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e48th\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edischarged\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCase 2 FLACC Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eHour\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e1st\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e2nd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e3rd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e4th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e5th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e6th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e12th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e24th\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003e48th\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFLACC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edischarged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eAlthough the PENG block is well established in the adult literature, evidence supporting its use in the pediatric population remains limited. Most existing reports have focused on school-aged children (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Data on the combined use of PENG and LFCN blocks in children under five years of age\u0026mdash;as exemplified by Case 2 (18 months old)\u0026mdash;are particularly scarce (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSonoanatomic studies in young children have demonstrated that the femoral nerve lies in close proximity to the target site (iliopsoas notch), indicating that local anesthetic dosing (mg/kg) must be carefully titrated (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Aksu et al. have described performing both blocks through a single needle insertion (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Our cases extend this approach to the pediatric population. No complications or signs of local anesthetic toxicity were observed with the doses used in our patients.\u003c/p\u003e \u003cp\u003eBeltramini et al. reported that VAS can be used for pain assessment in pediatric patients aged six years and older (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Reports also recommend the FLACC scale for evaluating postoperative pain in children between two months and seven years of age (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In our study, VAS was used to assess pain in the first case, whereas FLACC was employed for the second case, who was 18 months old.\u003c/p\u003e \u003cp\u003eRoy et al., in their published case series, reported that the combined use of PENG and LFCN blocks may provide more effective analgesia in hip surgery (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In our pediatric femoral fracture cases, the use of PENG\u0026thinsp;+\u0026thinsp;LFCN blocks was associated with a reduction or elimination of opioid requirements, which is consistent with the existing literature. For example, Orozko et al. reported an 8-year-old case in which the PENG\u0026thinsp;+\u0026thinsp;LFCN combination provided adequate analgesia, with no need for any analgesics or opioids during the first 72 hours postoperatively (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, Domagalska et al. emphasized that the PENG block enabled opioid-free pain management in children aged 2 and 4 years (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Other reports in the literature also indicate that the PENG block significantly reduces opioid consumption. In a series presented by Bunnel et al., one of three pediatric cases required no opioids, while in the remaining two cases, the first opioid requirement occurred relatively late, between 12 and 17 hours postoperatively (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsistent with the literature, analgesia was effective in both patients, opioid use was minimal or absent, motor function was preserved, and no adverse effects were observed. The feasibility of this technique in an 18-month-old child is particularly noteworthy given the limited literature in this age group. Additionally, the single-needle approach may reduce the invasiveness of the procedure and the risk of complications.\u003c/p\u003e \u003cp\u003eIn summary, the combined use of PENG and LFCN blocks appears to be a safe and effective strategy for perioperative analgesia in pediatric femoral neck surgery. These cases highlight the potential of this technique to reduce opioid requirements and enhance postoperative comfort in children. They also aim to contribute toward establishing a new standard for pediatric regional anesthesia practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003ePhone number\u003c/h2\u003e \u003cp\u003e+905439406027\u003c/p\u003e \u003c/p\u003e \u003cdiv class=\"Heading\"\u003eDeclarations\u003c/div\u003e \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eEthical approval was not required due to the nature of this case report.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from the patients\u0026rsquo; parents for publication of clinical details and images.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eOPK wrote the main manuscript text, prepared figures, tableHK wrote the main manuscript text, prepared figuresAll authors reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll relevant data are included within the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eElhamrawy A, Kerbage J, Veneziano G, Martin DP, Tobias JD. Pericapsular Nerve Group (PENG) Block in Pediatric Patients Undergoing Hip and Pelvic Surgical Procedures: An Educational Focused Review. J Pain Res. 2024;17:3697\u0026ndash;705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/JPR.S481273\u003c/span\u003e\u003cspan address=\"10.2147/JPR.S481273\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurbuz H, Colak T. Evaluation of inguinal sonoanatomy regarding pericapsular nerve group (PENG) block in children: the relation of femoral artery, femoral nerve, lateral femoral cutaneous nerve and iliopsoas notch. BMC Anesthesiol. 2025;25:144. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12871-025-03020-2\u003c/span\u003e\u003cspan address=\"10.1186/s12871-025-03020-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmadzadeh S, Schwab HM, O'Dell Duplechin M, Broocks KM, Hirsch JD, Drinkard J, Shekoohi S. Comparison of Pericapsular Nerve Group Block and Lumbar Epidural Block for Pain Management After Hip Surgery, Focusing on Pediatric Patients: A Narrative Review. Neurol Int. 2025;17:142. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/neurolint17090142\u003c/span\u003e\u003cspan address=\"10.3390/neurolint17090142\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBunnell AM, Smith JV. Pericapsular Nerve Group (PENG) Block for Pediatric Hip Surgery: A Report of Three Cases. Cureus. 2025;17:e78996. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.78996\u003c/span\u003e\u003cspan address=\"10.7759/cureus.78996\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGir\u0026oacute;n-Arango L, Peng PWH, Chin KJ, Brull R, Perlas A. Pericapsular Nerve Group (PENG) Block for Hip Fracture. Reg Anesth Pain Med. 2018;43:859\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/AAP.0000000000000847\u003c/span\u003e\u003cspan address=\"10.1097/AAP.0000000000000847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVetrone F, Saglietti F, Galimberti A, Pezzi A, Umbrello M, Cuttone G, et al. Pericapsular Nerve Group Block Plus Lateral Femoral Cutaneous Nerve Block vs. Fascia Iliaca Compartment Block in Hip Replacement Surgery. J Clin Med. 2025;14:984. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14030984\u003c/span\u003e\u003cspan address=\"10.3390/jcm14030984\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAksu C, Cesur S, Kuş A. Pericapsular nerve group block and lateral femoral cutaneous block with single needle entry are possible in pediatric patients. J Clin Anesth. 2021;71:110215. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jclinane.2021.110215\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinane.2021.110215\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeltramini A, Milojevic K, Pateron D. Pain Assessment in Newborns, Infants, and Children. Pediatr Ann. 2017;46:e387\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/19382359-20170921-03\u003c/span\u003e\u003cspan address=\"10.3928/19382359-20170921-03\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrottier ED, Ali S, Dor\u0026eacute;-Bergeron M-J, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health. 2022;27:429\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/pch/pxac048\u003c/span\u003e\u003cspan address=\"10.1093/pch/pxac048\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy R, Agarwal G, Pradhan C, Kuanar D. Total postoperative analgesia for hip surgeries: PENG block with LFCN block. Reg Anesth Pain Med. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/rapm-2019-100454\u003c/span\u003e\u003cspan address=\"10.1136/rapm-2019-100454\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrozco S, Mu\u0026ntilde;oz D, Jaramillo S, Herrera AM. Pediatric use of Pericapsular Nerve Group (PENG) block for hip surgical procedures. J Clin Anesth. 2019;57:143\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jclinane.2019.04.010\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinane.2019.04.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomagalska M, Wieczorowska-Tobis K, Reysner T, Geisler-Wojciechowska A, Grochowicka M, Kowalski G. Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report. J Pers Med. 2023;13:454. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jpm13030454\u003c/span\u003e\u003cspan address=\"10.3390/jpm13030454\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric anesthesia, Pericapsular nerve group block, Lateral femoral cutaneous nerve block, Femoral neck surgery, Regional anesthesia, Opioid-sparing analgesia","lastPublishedDoi":"10.21203/rs.3.rs-9058049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9058049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe importance of regional anesthesia techniques is increasing as part of multimodal analgesia strategies for managing postoperative pain in pediatric hip and femur surgeries.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e \u003cp\u003eWe aim to present two cases, aged 10 years and 18 months, scheduled for surgery due to femoral neck fractures. As part of multimodal pain management, ultrasound-guided PENG\u0026thinsp;+\u0026thinsp;LFCN blocks were performed in both cases. Postoperative pain was assessed using VAS and FLACC scales.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe advocate the use of these techniques in combination in the pediatric population, as they facilitate pain management and reduce opioid requirements. However, larger-scale studies are needed to provide more concrete evidence regarding their true risks and benefits.\u003c/p\u003e","manuscriptTitle":"Perioperative Analgesia with Combined Pericapsular Nerve Group (PENG) and Lateral Femoral Cutaneous Nerve Blocks in Pediatric Femoral Neck Surgery: A Two-Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-24 05:51:51","doi":"10.21203/rs.3.rs-9058049/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-23T13:17:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T02:32:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T16:59:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194164330933235929749403338408055059530","date":"2026-04-21T19:14:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71138490838744977173344621163264798205","date":"2026-04-19T14:53:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261991828311911687909882333101705558583","date":"2026-04-16T17:31:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11371863903002337663538706872884999635","date":"2026-04-16T17:31:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-21T17:31:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111195265214110606021974240307318859987","date":"2026-03-21T02:30:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138679060347590184467010674245551912334","date":"2026-03-19T09:06:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148840205992381495965849089409840363738","date":"2026-03-18T19:48:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T14:43:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-10T09:49:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-07T11:32:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-07T11:31:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-03-07T11:22:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3ab8ae81-ff66-4be7-a526-8147b2ea00cb","owner":[],"postedDate":"March 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T06:26:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-24 05:51:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9058049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9058049","identity":"rs-9058049","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}