P-097 - (Poster #97) DEVELOPMENT AND VALIDATION OF AN OBJECTIVE CHECKLIST FOR ASSESSING THE PERFORMANCE OF AN ULTRASOUND-GUIDED PERICAPSULAR NERVE GROUP (PENG) BLOCK

Background: The Pericapsular Nerve Group (PENG) block is a relatively new ultrasound-guided regional anesthesia technique increasingly utilized as part of a multimodal analgesic approach for hip surgery. It provides targeted analgesia by anesthetizing the articular branches of the femoral, obturator, and accessory obturator nerves. Unlike traditional approaches such as the femoral nerve or fascia iliaca block, the PENG block is motor-sparing, promoting earlier ambulation and more rapid postoperative rehabilitation. However, despite its clinical advantages, variability in technique and a lack of standardized guidelines can contribute to inconsistent results and a higher likelihood of incomplete or failed blocks.

Purpose/Objectives: A comprehensive literature review was conducted to identify best evidence-based practices for developing procedural checklists in regional anesthesia. The analysis revealed three key themes: the need for validated tools to assess procedural performance, the importance of outcome-based training in skill acquisition, and the value of assessment tools in distinguishing novice from expert practitioners.
These findings informed the development of an evidence-based checklist to standardize the performance of the PENG block. To ensure consensus and rigor, the Modified Delphi Method was employed, utilizing multiple rounds of anonymous surveys and structured feedback from a panel of recognized experts. This approach is particularly effective in healthcare settings where empirical data may be limited or difficult to obtain.
The result was a practical, consensus-driven tool designed to support education, promote procedural consistency, and improve clinical outcomes related to the performance of the PENG block.

Methods: Institutional ethical approval was obtained from the Advarra Institutional Review Board (IRB), with exemption status granted as the study was based on expert opinion and did not involve patients or protected health information.

An anonymous online survey was developed using Microsoft Forms, a secure platform that allows for confidential and independent response submission. Each proposed checklist item was evaluated using a 5-point Likert scale to assess clarity and importance, with an open comment section included for qualitative feedback.
Participants received an email invitation detailing the study’s purpose, consent information, and survey link. A reminder was sent two weeks later. In Round One, responses from 17 participants were analyzed. Items that failed to reach the predefined 75% consensus threshold for importance or necessity were flagged for revision.
The item “image acquisition” did not meet the threshold. Although “sterile preparation” and “skin localization” achieved 75% agreement, conflicting comments prompted revisions. These items were refined and rephrased for Round Two.
The revised survey was sent to the original participants, followed by another reminder after two weeks. Final consensus was defined as at least 75% agreement on all items with no further suggested revisions. This criterion was met, resulting in a finalized checklist.

Results: The initial Modified Delphi survey achieved a 68% response rate, with 17 of 25 invited regional anesthesia experts providing detailed feedback on the checklist. Overall consensus was strong, with all items receiving over 75% agreement for inclusion in the final version. Respondents consistently endorsed the checklist for its clarity, comprehensiveness, and potential to enhance procedural accuracy, improve patient outcomes, and standardize PENG block performance. Experts agreed that the tool would reduce technique variability and support adherence to evidence-based practice.
Key components—such as identification of anatomical landmarks, sterile preparation, in-plane needle insertion, and post-block considerations—received 100% agreement and were unanimously recognized as essential for both clinical and educational use.
One area of variability emerged regarding ultrasound image acquisition. Four respondents noted differing preferences in transducer placement: while the checklist recommended beginning at the anterior inferior iliac spine (AIIS) and scanning inferior, some experts preferred starting at the femoral head and scanning superior. Despite the variation in technique, all experts agreed that both methods identified the required anatomical landmarks for block performance.
To address the item that did not reach full consensus, a second, abbreviated survey was distributed. Nine participants responded, resulting in strengthened agreement—over 89% consensus across all items, with 12 of 13 components reaching 100%. No new suggestions or imaging techniques were introduced, indicating content saturation and confirming the robustness of the final checklist.
Across both rounds, participants unanimously affirmed the critical importance of key elements, including pre-procedure timeout, sonographic landmark identification, sterile technique, in-plane needle guidance, sharps safety, and post-procedure patient monitoring.

Conclusions/Implications for future research and/or clinical care: This study introduces a consensus-driven, expert-validated checklist for the PENG block, designed to enhance procedural consistency, reproducibility, and patient safety. As regional anesthesia increasingly emphasizes standardized education and opioid-sparing techniques, the integration of structured tools such as this checklist is critical to advancing clinical best practices and maintaining high-quality care across varied healthcare environments.
The findings highlight the checklist’s value as a reliable and reproducible instructional aid, suitable for training both novice anesthesia providers and experienced clinicians who are newly incorporating the PENG block into their practice. Future comparative studies evaluating traditional instructional methods against checklist-based training approaches would provide additional validation and support the broader integration of structured assessment tools in regional anesthesia education.