Steinhaus Michael E, Rosneck James, Ahmad Christopher S, Lynch T Sean
Columbia University Medical Center, New York, NY.
Am J Orthop (Belle Mead NJ). 2018 Jun;47(6). doi: 10.12788/ajo.2018.0049.
Pain control following hip arthroscopy presents a significant clinical challenge, with postoperative pain requiring considerable opioid use. Peripheral nerve blocks (PNBs) have emerged as one option to improve pain and limit the consequences of opioid use. The purpose of this study is to provide a comprehensive review of outcomes associated with PNB in hip arthroscopy. We hypothesize that the use of PNB in hip arthroscopy leads to improved outcomes and is associated with few complications. A systematic review of PubMed, Medline, Scopus, and Embase databases was conducted through January 2015 for English-language articles reporting outcome data, with 2 reviewers independently reviewing studies for inclusion. When available, similar outcomes were combined to generate frequency-weighted means. Six studies met the inclusion criteria for this review, reporting on 710 patients undergoing hip arthroscopy. The mean ages were 37.0 and 37.7 years for the PNB and comparator groups, respectively, with a reported total of 281 (40.5%) male and 412 (59.5%) female patients. Postoperative post-anesthesia care unit (PACU) pain was consistently reduced in the PNB group, with the use of a lower morphine equivalent dose and lower rates of inpatient admission, compared with that in the control groups. Postoperative nausea and/or vomiting as well as PACU discharge time showed mixed results. High satisfaction and few complications were reported. In conclusion, PNB is associated with reductions in postoperative pain, analgesic use, and the rate of inpatient admissions, though similar rates of nausea/vomiting and time to discharge were reported. Current PNB techniques are varied, and future research efforts should focus on examining which of these methods provides the optimal risk-benefit profile in hip arthroscopy.
髋关节镜检查后的疼痛控制是一项重大的临床挑战，术后疼痛需要大量使用阿片类药物。外周神经阻滞（PNB）已成为改善疼痛并限制阿片类药物使用后果的一种选择。本研究的目的是全面综述与髋关节镜检查中PNB相关的结果。我们假设在髋关节镜检查中使用PNB可改善结果且并发症较少。通过检索截至2015年1月的PubMed、Medline、Scopus和Embase数据库，对报告结果数据的英文文章进行系统综述，由2名评审员独立评审纳入研究。如有可用数据，将相似结果合并以生成频率加权均值。六项研究符合本综述的纳入标准，报告了710例接受髋关节镜检查的患者。PNB组和对照组的平均年龄分别为37.0岁和37.7岁，报告的患者总数为男性281例（40.5%），女性412例（59.5%）。与对照组相比，PNB组术后麻醉后护理单元（PACU）的疼痛持续减轻，吗啡等效剂量较低，住院率也较低。术后恶心和/或呕吐以及PACU出院时间的结果不一。报告显示满意度高且并发症少。总之，PNB与术后疼痛减轻、镇痛药物使用减少以及住院率降低相关，尽管恶心/呕吐发生率和出院时间相似。目前的PNB技术多种多样，未来的研究应聚焦于探究哪种方法在髋关节镜检查中能提供最佳的风险效益比。
