Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, U.S.A.
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, U.S.A..
Arthroscopy. 2017 Dec;33(12):2170-2176. doi: 10.1016/j.arthro.2017.06.036. Epub 2017 Aug 31.
To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery.
An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Demographic data, perioperative pain scores, narcotic consumption, incidence of falls, and iatrogenic peripheral neuritis were collected for analysis. Postoperative data were then collected at routine clinical visits.
A total of 193 patients were included in this study (65 males, 125 females). Of them, 105 patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular "cocktail." There were no significant differences in patient demographics, history of chronic pain (P = .35), worker's compensation (P = .24), preoperative pain scores (P = .69), or intraoperative doses of narcotics (P = .40). Patients who received preoperative femoral nerve blocks reported decreased pain during their time in PACU (P = .0001) and on hospital discharge (P = .28); however, there were no statistically significant differences in patient-reported pain scores at postoperative weeks 1 (P = .34), 3 (P = .64), and 6 (P = .70). Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P = .009) and iatrogenic peripheral neuritis (P = .0001).
Preoperative femoral nerve blocks are associated with decreased immediate postoperative pain, whereas intraoperative intra-articular anesthetic injections provide effective postoperative pain control in patients undergoing arthroscopic hip surgery and result in a significant reduction in the rate of postoperative falls and iatrogenic peripheral neuritis.
Level III, retrospective comparative study.
比较关节内阻滞与股神经阻滞在接受关节镜髋关节手术患者中的临床疗效和术后跌倒及周围神经炎发生率。
对 2013 年 11 月至 2015 年 4 月间由同一位医生进行的择期关节镜髋关节手术的连续患者进行了机构审查委员会批准的回顾性研究。将受试者分为 2 组：接受术前股神经阻滞以控制围手术期疼痛的患者和术后接受关节内“鸡尾酒”注射的患者。收集人口统计学数据、围手术期疼痛评分、阿片类药物用量、跌倒发生率和医源性周围神经炎发生情况进行分析。然后在常规临床就诊时收集术后数据。
本研究共纳入 193 例患者（男 65 例，女 125 例）。其中 105 例患者接受术前股神经阻滞，88 例患者接受术中关节内“鸡尾酒”注射。患者的人口统计学数据、慢性疼痛史（P=0.35）、工人赔偿（P=0.24）、术前疼痛评分（P=0.69）或术中阿片类药物剂量（P=0.40）均无显著差异。接受术前股神经阻滞的患者在 PACU 期间（P=0.0001）和出院时（P=0.28）疼痛减轻，但术后 1 周（P=0.34）、3 周（P=0.64）和 6 周（P=0.70）的患者报告疼痛评分无统计学差异。关节内阻滞的应用与术后跌倒发生率降低显著相关（P=0.009）和医源性周围神经炎（P=0.0001）。
术前股神经阻滞可降低术后即刻疼痛，而术中关节内麻醉注射可为接受关节镜髋关节手术的患者提供有效的术后疼痛控制，并显著降低术后跌倒和医源性周围神经炎的发生率。
三级，回顾性比较研究。
