Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A..
Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
Arthroscopy. 2019 Sep;35(9):2608-2616. doi: 10.1016/j.arthro.2019.03.056. Epub 2019 Aug 8.
To determine in a prospective, randomized fashion whether liposomal bupivacaine extends the effectiveness of decreased pain scores and reduces narcotic requirements following hip arthroscopy when used in addition to a fascia iliaca blockade with plain bupivacaine alone.
Double-blinded prospective randomized controlled trial of participants undergoing hip arthroscopy. Randomized to receive a fascia iliaca blockade with 40 mL 0.25% plain bupivacaine (100 mg; control group) or 20 mL 0.5% plain bupivacaine (100 mg) plus 20 mL liposomal bupivacaine (266 mg; study group). The primary outcome was Defense and Veterans Pain Rating Scale (DVPRS) scores in the postanesthesia care unit and on postoperative days (POD) 1, 2, 3, and 14. Secondary outcomes included postoperative opioid consumption and subjective loss of anterior thigh sensation.
Seventy-four patients were enrolled, and 70 completed the study; 37 were randomized to the control group and 33 to the study group. There was no significant difference in postoperative DVPRS scores at any time point. There was no significant difference in total postoperative opioid use during any postoperative time points. While most patients reported anterior thigh numbness at discharge, significantly more patients in the study group reported anterior thigh numbness at POD2 (control, 19/37 numb vs study, 32/33 numb; P < .0001) and at POD3 (control, 8/37 numb vs study, 26/33 numb; P < .0001).
In this prospective evaluation comparing plain bupivacaine versus the liposomal formulation administered via a fascia iliaca blockade there were no significant differences in postoperative pain scores and narcotic pill usage. Given the highly significant findings of prolonged anterior thigh numbness out to POD3 in patients who received liposomal bupivacaine, this formulation did exhibit prolonged effects; however, it did not provide improved pain control when used in this surgical population, likely due to the innervation of the hip capsule from differential nerve plexi. Given the 6-fold increased cost of using the liposomal formulation, we are unable to recommend its use via a fascia iliaca blockade for hip arthroscopy.
Level I, therapeutic study.
前瞻性、随机研究，旨在确定当单独使用单纯布比卡因行髂筋膜阻滞时，添加脂质体布比卡因是否可以延长髋关节镜术后疼痛评分降低的效果并减少阿片类药物的需求。
对接受髋关节镜手术的参与者进行双盲前瞻性随机对照试验。随机分为接受 40ml 0.25%单纯布比卡因（100mg；对照组）或 20ml 0.5%单纯布比卡因（100mg）加 20ml 脂质体布比卡因（266mg；研究组）的髂筋膜阻滞。主要结局是麻醉后护理单元和术后第 1、2、3、14 天的防御和退伍军人疼痛评分量表（DVPRS）评分。次要结局包括术后阿片类药物的使用和主观大腿前感觉丧失。
74 例患者入组，70 例完成研究；37 例随机分为对照组，33 例随机分为研究组。在任何时间点，术后 DVPRS 评分均无显著差异。在任何术后时间点，总术后阿片类药物使用均无显著差异。虽然大多数患者在出院时报告大腿前麻木，但研究组在 POD2（对照组，19/37 麻木；研究组，32/33 麻木；P<.0001）和 POD3（对照组，8/37 麻木；研究组，26/33 麻木；P<.0001）时报告大腿前麻木的患者明显更多。
在比较单纯布比卡因与脂质体制剂经髂筋膜阻滞给药的前瞻性评估中，术后疼痛评分和阿片类药物使用无显著差异。鉴于接受脂质体布比卡因的患者在 POD3 时大腿前麻木时间延长的显著发现，该制剂确实表现出延长的作用；然而，在这种手术人群中，它并没有提供更好的疼痛控制效果，这可能是由于髋关节囊的神经支配来自不同的神经丛。鉴于使用脂质体制剂的成本增加了 6 倍，我们无法推荐其在髋关节镜检查中通过髂筋膜阻滞使用。
I 级，治疗性研究。
