Providing culturally safe regional anaesthesia: bilateral pericapsular nerve group (PENG) blocks versus epidural

Regional anaesthesia is a key element in modern perioperative pain management. However, additional risks are taken while performing these procedures, and adequate consent needs to be secured. In Indigenous cultures, the traditional doctor-patient relationships can differ from those western-trained healthcare workers are used to and can raise concerns in patients or their families. Peripheral nerve blocks can be combined to efficiently replace neuraxial approaches. They can appear more acceptable to patients or their family and gain their support compared with neuraxial blocks traditionally offered for certain long and invasive surgeries. Here, we describe the use of bilateral pericapsular nerve group (PENG) blocks instead of an epidural in the management of a young Māori female patient undergoing a bilateral revision hip procedure, requiring a total of 8 hours of surgical and anaesthetic time. Bilateral PENG blocks facilitated consent by the whānau (the extended family group) for regional anaesthesia under general anaesthesia, were easily inserted, and provided efficient perioperative analgesia for the daylong and bilateral procedure. They also provided pain relief for 24 hours before the introduction of minimally dosed morphine nurse-controlled analgesia in this patient with respiratory comorbidity. The ability to propose various regional anaesthesia techniques can lead to personalised anaesthetic care, respectful of the patient's or family's concerns or expectations, and remarkably favourable outcomes.