Bilateral Ultrasound-Guided Dual-PENG Block for Pelvic and Acetabular Fracture Surgery: Anatomical Rationale and Technical Hypothesis

This technical hypothesis proposes an anatomical and procedural framework for the use of bilateral ultrasound-guided PENG block (Dual-PENG block) as an adjunctive component of multimodal analgesia in patients undergoing surgery for pelvi-acetabular fractures. While the PENG block is traditionally used for hip fractures, the authors hypothesize that its application can be extended to cover the anterior pericapsular, acetabular, and pubic ramus-related pain components. The manuscript details the anatomical rationale, technical ultrasound-guided approach, safety considerations (including local anesthetic dosing), and a proposed decision algorithm for clinical practice.