This composite educational image illustrates the Pericapsular Nerve Group (PENG) block, a regional anesthesia technique for hip analgesia. Panel A shows the clinical setup, including the patient’s supine position and the transverse orientation of a curved-array ultrasound probe at the level of the inguinal crease. Panel B presents the corresponding sonographic anatomy. Key landmarks include the hyperechoic bony contours of the anterior inferior iliac spine (AIIS) and the iliopubic eminence (IPE). The psoas tendon (PT) is identified as a hypoechoic oval structure resting between these bony prominences. The femoral artery (FA) is visualized medially as an anechoic, pulsatile vessel. A dashed red arrow demonstrates the in-plane needle trajectory, targeting the fascial plane between the psoas tendon and the pubic ramus. This block specifically targets the articular branches of the femoral nerve, obturator nerve, and accessory obturator nerve to provide sensory blockade of the anterior hip capsule without significant motor impairment.

Diagnostic ultrasound images illustrating the Pericapsular Nerve Group (PENG) block for regional anesthesia. The composite contains two panels showing the cross-sectional anatomy of the anterior hip region. The left panel identifies key landmarks: the femoral artery (FA), femoral vein (FV), and femoral nerve (FN) located medially and superiorly. Deep to these lie the psoas tendon (PT), iliopubic eminence (IPE), and anterior inferior iliac spine (AIIS). The right panel demonstrates the clinical implementation of the block, where hypoechoic local anesthetic (AL) is seen spreading within the fascial plane between the psoas tendon and the underlying bony cortex (IPE and AIIS). The images highlight the anatomical plane containing sensory branches of the femoral, obturator, and accessory obturator nerves targeted for hip fracture analgesia. Orientation arrows indicate anterior and medial directions, emphasizing the deep approach required to reach the periarticular space while avoiding superficial neurovascular structures.

This diagnostic ultrasound image demonstrates the technique for a PENG (Pericapsular Nerve Group) block in the hip region. The image shows a transverse view of the pelvic anatomy, focusing on the space between the anterior inferior iliac spine (AIIS) and the iliopubic eminence. The iliopsoas tendon is clearly identified as a prominent, hyperechoic (bright), oval-shaped structure with a homogeneous internal texture. A needle tip is visualized and labeled, positioned laterally to the iliopsoas tendon. The needle path enters from a lateromedial direction to target the fascial plane beneath the tendon, adjacent to the bone surface of the ilium. This modified technique is intended for regional anesthesia to provide analgesia for hip fractures or surgeries while minimizing quadriceps motor weakness by depositing local anesthetic away from the femoral nerve.

This diagnostic ultrasound image demonstrates the 'Shamrock sign' anatomy used for a transmuscular quadratus lumborum (TQL) block. The sonogram shows a cross-sectional view of the posterior abdominal wall with clearly labeled anatomical structures. From anterior to posterior (left to right), the external oblique (EO), internal oblique (IO), and transversus abdominis (TA) muscles are visible as distinct superficial layers. Deep to these, the quadratus lumborum (QL) muscle is positioned adjacent to the psoas major (PM) muscle. The transverse process (TP) of the lumbar vertebra and the erector spinae (ES) muscle are situated posteriorly. White arrowheads point to a hypoechoic region between the QL and PM muscles, representing the interfascial plane where local anesthetic injectate spreads during the procedure. The image illustrates the 'Shamrock' configuration formed by the QL, PM, and ES muscles surrounding the transverse process, providing a critical landmark for anesthesiologists to perform regional anesthesia for postoperative pain management.

This diagnostic ultrasound image demonstrates the regional anatomy for a posterior Quadratus Lumborum Block (QLB type 2). The sonogram shows a transverse view of the abdominal wall and paraspinal musculature at the level of the fourth lumbar vertebra (L4). Key anatomical structures are labeled, including the superficial external oblique (EO) muscle, the quadratus lumborum (QL) muscle, the psoas major (PM) muscle situated anteriorly, and the erector spinae (ES) muscle group located posteriorly. The hyperechoic shadow of the L4 vertebral body serves as a deep posterior landmark. A yellow arrow identifies the patient's skin surface. A red arrow illustrates the planned needle trajectory for a posterior QLB, originating from the skin, traversing the EO, and targeting the interfacial plane on the posterior aspect of the QL muscle (the 'shamrock sign' area). This image is an essential educational resource for regional anesthesia, illustrating the sonographic landmarks required for safe and effective truncal nerve blocks.