Kay Jeffrey, de Sa Darren, Memon Muzammil, Simunovic Nicole, Paul James, Ayeni Olufemi R
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Arthroscopy. 2016 Apr;32(4):704-15.e1. doi: 10.1016/j.arthro.2015.12.022. Epub 2016 Feb 20.
This systematic review examined the efficacy of perioperative nerve blocks for pain control after hip arthroscopy.
The databases Embase, PubMed, and Medline were searched on June 2, 2015, for English-language studies that reported on the use of perioperative nerve blocks for hip arthroscopy. The studies were systematically screened and data abstracted in duplicate.
Nine eligible studies were included in this review (2 case reports, 2 case series, 3 non-randomized comparative studies, and 2 randomized controlled trials). In total, 534 patients (534 hips), with a mean age of 37.2 years, who underwent hip arthroscopy procedures were administered nerve blocks for pain management. Specifically, femoral (2 studies), fascia iliaca (2 studies), lumbar plexus (3 studies), and L1 and L2 paravertebral (2 studies) nerve blocks were used. All studies reported acceptable pain scores after the use of nerve blocks, and 4 studies showed significantly lower postoperative pain scores acutely with the use of nerve blocks over general anesthesia alone. The use of nerve blocks also resulted in a decrease in opioid consumption in 4 studies and provided a higher level of patient satisfaction in 2 studies. No serious acute complications were reported in any study, and long-term complications from lumbar plexus blocks, such as local anesthetic system toxicity (0.9%) and long-term neuropathy (2.8%), were low in incidence.
The use of perioperative nerve blocks provides effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques.
Level IV, systematic review of Level I to Level IV studies.
本系统评价探讨了围手术期神经阻滞用于髋关节镜检查后疼痛控制的疗效。
于2015年6月2日检索了Embase、PubMed和Medline数据库，查找关于围手术期神经阻滞用于髋关节镜检查的英文研究。对研究进行系统筛选，并由两人独立提取数据。
本评价纳入了9项合格研究（2篇病例报告、2篇病例系列研究、3篇非随机对照研究和2篇随机对照试验）。共有534例患者（534髋）接受了髋关节镜手术，这些患者平均年龄为37.2岁，均接受了神经阻滞以进行疼痛管理。具体而言，使用了股神经阻滞（2项研究）、髂筋膜阻滞（2项研究）、腰丛阻滞（3项研究）以及L1和L2椎旁神经阻滞（2项研究）。所有研究均报告使用神经阻滞后疼痛评分可接受，4项研究表明，与单纯全身麻醉相比，使用神经阻滞可显著降低术后急性疼痛评分。4项研究还显示，使用神经阻滞可减少阿片类药物的用量，2项研究表明患者满意度更高。所有研究均未报告严重急性并发症，腰丛阻滞的长期并发症，如局部麻醉药全身毒性（0.9%）和长期神经病变（2.8%）的发生率较低。
围手术期神经阻滞用于髋关节镜检查后可提供有效的疼痛管理，在减轻术后急性疼痛和补充阿片类药物用量方面可能比其他镇痛技术更有效。
IV级，对I级至IV级研究的系统评价。
