CHALLENGE JOURNAL OF PERIOPERATIVE MEDICINE 1 (1) (2023) 17–19 * Corresponding author. Tel.: +90-442-344-8796 ; Fax: +90-442-236-1301 ; E-mail address: elamdtoglu@gmail.com (E. N. Medetoglu) ISSN: 2980-292X / DOI: https://doi.org/10.20528/cjpm.2023.01.005 Case Report Pericapsular nerve group (PENG) block as a sole anesthetic method for malignant soft tissue excision Ela Nur Medetoglu a, * , Veysel Koksal a , Mehmet Akif Yilmaz a , Elif Oral Ahiskalioglu a a Department of Anesthesiology and Reanimation, Atatürk University, Faculty of Medicine, Erzurum, Türkiye A B S T R A C T Since its first description by Philippe WH Peng in 2018, the Pericapsular Nerve Group (PENG) block, a novel regional anesthetic procedure, has been gaining in popularity. In order to provide appropriate analgesia, an ultrasound-guided local anesthetic in- jection around the hip joint is performed. We presented, in this case, the successful management of the PENG block for surgical anesthesia in the excision of a malignant soft tissue tumor in the proximal tibia of a 73-year-old female patient. Adequate sensory and motor blocks were obtained, al- lowing a 70-minute surgery without using additional analgesics. Postoperative pain scores were low, and the patient was discharged without complications. A R T I C L E I N F O Article history: Received 4 April 2023 Revised 30 April 2023 Accepted 25 May 2023 Keywords: Pericapsular nerve group block Surgical anesthesia High risk patient 1. Introduction Pericapsular Nerve Group (PENG) block is a rela- tively novel regional anesthesia technique that has gained increasing popularity in recent years. The PENG block is an injection that is given peri-capsularly around the hip joint under ultrasound guidance. It was first described in 2018 for analgesia after hip fractures [1]. The anterior inferior iliac bone and iliopubic emi- nence are used as the anatomical landmark. Local anes- thetic is injected under and into the fascial layers that separate the iliopsoas muscle from the bone surface. The hip joint capsule is innervated by the femoral nerve and also several smaller nerves as the articular braches of the femoral, the articular branches of the obturator and the accessory obturator nerve that supply the an- terior capsule. The quadratus femoris nerve supplies the posterior capsule. In this case, we present the application of PENG block for successful surgical anesthesia in the excision of malignant soft tissue in the proximal tibia. Written consent was obtained from the patient for the publica- tion of the article. 2. Case Report A 73-year-old 80 kg female patient with ASA-III, a medical history of coronary artery disease, hyperten- sion and atrial fibrillation had a mass measuring 15x11x7.6 cm in the medial right proximal tibia. Mass excision was planned for the patient. Due to the loca- tion of the lesion and comorbidities, we decided to per- form PENG block for surgical anesthesia. Standard monitoring was performed on the patient in the oper- ating room. The US probe (Xperius®, B Braun-Philips, C5-2 broadband curved array transducer, Melsungen, Germany) was covered with a sheath under aseptic conditions. After the anterior inferior iliac spine was palpated, a convex probe was placed transversely on it. The probe was then rotated 45 degrees to visualize the pubic ramus. The pectineus, iliopsoas muscle, and fem- oral artery were visualized. After 2 ml saline injection to confirm the correct spreading then, a 100mm ultra- sound visible needle (Stimuplex® Ultra 360®, B Braun, Melsungen, Germany) was inserted lateral to medial and 30 ml of local anesthetic (15 ml 2% lidocaine, 15 ml 0.5% bupivacaine) was injected between the psoas ten- don and the pubis ramus. After approximately 20