Shoulder Pericapsular Nerve Group Block Utilization in the Emergency Department: A Case Series

Proximal humerus fractures and shoulder dislocations are common emergency department (ED) presentations that require painful reductions or immobilization, often in patients at increased risk for complications from opioids or procedural sedation. The shoulder pericapsular nerve group (PENG) block has been proposed as a motor-sparing regional anesthetic technique that may provide effective shoulder analgesia while minimizing phrenic nerve involvement. We evaluated the feasibility, analgesic effectiveness, and safety of the PENG block for ED patients with shoulder dislocations (SD) or proximal humerus fractures (HF).

The study was a retrospective cohort of adult ED patients who presented to an urban level 1 trauma center with SD or HF who received a shoulder PENG block between January 1 to December 31, 2023. Blocks were performed under ultrasound guidance using a high-frequency linear probe with in-plane needle approach and injection of local anesthetic adjacent to the pericapsular nerves. Patient data were abstracted from the electronic medical record and included demographics, pain scores, opioid administration, procedural sedation use, complications, and ED disposition. Injuries were analyzed separately for SD and HF.

Eight patients had shoulder PENG blocks: four with SD and four with HF. HF patients were predominantly female (75%) with a median age of 72. Patients with SDs were predominantly male (75%) with a median age of 56. Patients with SD reported a median 6-point decrease in pain (67% reduction) following block placement, and no patients required procedural sedation for shoulder reduction. Patients with HF reported a median 6-point decrease in pain (58% reduction). Patients with SD received a mean of 7 MMEs and those with HF 14 MMEs before block placement; no patient required additional opioid analgesia after block placement during the ED stay. No block-related complications were documented.

In this small cohort, the shoulder PENG block was feasible, well-tolerated, and associated with substantial pain reduction for patients with shoulder dislocations and proximal humerus fractures. This technique may provide a phrenic-sparing, opioid-sparing alternative to traditional analgesia and may reduce the need for procedural sedation. Further prospective study is warranted to compare its effectiveness with established regional anesthesia techniques.