Andrew P. Dold, University of Toronto, Division of Orthopaedic Surgery, 100 College Street, Room 302, Toronto, ON M5G 1L5, Canada.
Am J Sports Med. 2014 Jan;42(1):144-9. doi: 10.1177/0363546513510392. Epub 2013 Nov 27.
The utility of a femoral nerve block as an adjunct for pain management has been recognized for various surgical techniques but has yet to be examined in the preoperative setting as an adjunct to general anesthesia for improved postoperative pain control in hip arthroscopic surgery.
To evaluate the safety and efficacy of a preoperative femoral nerve block for postoperative pain control in patients undergoing hip arthroscopic surgery.
Cohort study; Level of evidence, 3.
A retrospective chart review of 108 consecutive hip arthroscopic surgery cases (in 103 patients) was carried out. All patients underwent arthroscopic surgery under a general anesthetic with or without a preoperative femoral nerve block. Groups were compared with respect to patient sex, age, and body mass index (BMI); physical status classification according to the American Society of Anesthesiologists (ASA); procedure performed; operative time; total intraoperative morphine-equivalent dose; pain scores (0-10 scale) recorded at 0, 15, 30, 45, and 60 minutes postoperatively in the post-anesthesia care unit (PACU); total morphine-equivalent dose in the PACU; presence of nausea or vomiting in the PACU; time to discharge from the PACU; oxycodone consumption in the surgical day care unit (SDCU); and maximal patient-reported pain score in the SDCU.
Twelve cases were excluded from the analysis for a total of 96 cases (in 92 patients). Forty patients had general anesthesia alone (group A), and 56 patients had a preoperative femoral nerve block before the induction of general anesthesia (group B). There was no significant difference between the groups with regard to sex, age, weight, height, BMI, ASA classification, or type of procedure performed. Patients who received a femoral nerve block also received a significantly lower total intraoperative morphine-equivalent dose than did those patients who did not receive a block. Postoperative patient-reported pain scores were lower at all time points for the femoral nerve block group; however, a statistical significance was seen only at the 60-minute postoperative time point. Patients who did not receive a block had significantly higher morphine-equivalent doses in the PACU. There was no difference in the rates of nausea and vomiting and time to discharge from the PACU between the 2 groups. Oxycodone consumption in the SDCU was similar between the groups, but the femoral nerve block group had significantly lower maximal patient-reported pain scores in the SDCU. Two patients in the general anesthesia group were admitted to the hospital postoperatively because of inadequate postoperative pain control. No complications were noted in any patient with regard to the femoral nerve block.
A preoperative femoral nerve block is a relatively safe procedure that may decrease the requirement for intraoperative morphine while providing effective postoperative pain control in patients undergoing hip arthroscopic surgery.
股神经阻滞作为一种辅助手段用于各种手术技术的疼痛管理已得到认可，但尚未在术前作为全身麻醉的辅助手段进行检查，以改善髋关节镜手术的术后疼痛控制。
评估术前股神经阻滞在髋关节镜手术患者中作为术后疼痛控制辅助手段的安全性和有效性。
队列研究；证据水平，3 级。
对 108 例连续髋关节镜手术病例（103 例患者）进行回顾性图表审查。所有患者均在全身麻醉下接受关节镜手术，其中包括或不包括术前股神经阻滞。比较组间患者性别、年龄和体重指数（BMI）；根据美国麻醉医师协会（ASA）的身体状况分类；手术类型；手术时间；总术中吗啡等效剂量；术后麻醉后监护病房（PACU）中记录的 0、15、30、45 和 60 分钟时的疼痛评分（0-10 分）；PACU 中的总吗啡等效剂量；PACU 中的恶心或呕吐发生率；PACU 出院时间；手术日病房（SDCU）中的羟考酮消耗量；以及 SDCU 中患者报告的最大疼痛评分。
共排除 12 例病例，总共有 96 例（92 例患者）被纳入分析。40 例患者仅接受全身麻醉（A 组），56 例患者在全身麻醉诱导前接受术前股神经阻滞（B 组）。两组间性别、年龄、体重、身高、BMI、ASA 分类或手术类型无显著差异。接受股神经阻滞的患者术中接受的吗啡等效总剂量明显低于未接受阻滞的患者。股神经阻滞组的所有时间点患者报告的术后疼痛评分均较低，但仅在术后 60 分钟时具有统计学意义。未接受阻滞的患者在 PACU 中接受的吗啡等效剂量明显较高。两组之间 PACU 的恶心和呕吐发生率以及出院时间无差异。SDCU 中羟考酮的消耗量在两组之间相似，但 SDCU 中股神经阻滞组患者报告的最大疼痛评分明显较低。全身麻醉组中有 2 例患者因术后疼痛控制不佳而住院。在任何接受股神经阻滞的患者中均未发现与股神经阻滞相关的并发症。
术前股神经阻滞是一种相对安全的操作方法，可减少髋关节镜手术患者术中吗啡的需求，同时提供有效的术后疼痛控制。
