Bravo Daniela, Layera Sebastián, Aliste Julián, Jara Álvaro, Fernández Diego, Barrientos Cristián, Wulf Rodrigo, Muñoz Gonzalo, Finlayson Roderick J, Tran De Q
Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago, Chile, 8380456.
Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago, Chile, 8380456.
J Clin Anesth. 2020 Nov;66:109907. doi: 10.1016/j.jclinane.2020.109907. Epub 2020 Jun 2.
Comparison of ultrasound-guided lumbar plexus block (LPB) and suprainguinal fascia iliaca block (SIFIB) in patients undergoing total hip arthroplasty (THA).
Randomized equivalence trial.
University Hospital.
Sixty patients undergoing primary THA.
Patients were randomly allocated to receive ultrasound-guided LPB (n = 30) or SIFIB (n = 30). The local anesthetic agent (40 mL of levobupivacaine 0.25% with epinephrine 5 μg/mL) and block adjuvant (4 mg of intravenous dexamethasone) were identical in all subjects. Postoperatively, all patients received patient-controlled intravenous analgesia (morphine) as well as acetaminophen and ketoprofen during 48 h.
A blinded investigator recorded morphine consumption at 24 and 48 h as well as time to first morphine request, pain scores at 3, 6, 12, 24 and 48 h, incidence of adverse events, time to readiness for discharge, and length of hospital stay. The blinded investigator also carried out sensorimotor block assessment at 3, 6 and 24 h using a 10-point sensorimotor composite scale.
No intergroup differences were found in terms of cumulative morphine consumption at 24 h (95% CI: -4.0 mg to 2.0 mg) and 48 h (95% CI, -5.0 mg to 2.0 mg) or time to first morphine request. Furthermore, pain scores were similar at all time intervals after 3 h. There were no intergroup differences in terms of composite sensorimotor scores at 3 and 6 h. However, SIFIB lasted longer than lumbar plexus block as evidenced by a higher composite score at 24 h. No intergroup differences were found in terms of complications. Compared with LPB, SIFIB was associated with shorter time to readiness for discharge (3 [1-4] vs. 2 [1-3] days; P = 0.042) and length of hospital stay (3 [2-5] vs. 3 [2-4] days; P = 0.048).
For THA, no differences were found between LPB and SIFIB in terms of breakthrough morphine requirement and pain control. However, SIFIB resulted in a longer block and was associated with shorter time to readiness for discharge as well as decreased hospital stay.
比较超声引导下腰丛阻滞（LPB）和腹股沟上髂筋膜阻滞（SIFIB）在全髋关节置换术（THA）患者中的应用效果。
随机等效性试验。
大学医院。
60例行初次THA的患者。
患者被随机分配接受超声引导下LPB（n = 30）或SIFIB（n = 30）。所有受试者使用的局部麻醉剂（40 mL 0.25%左旋布比卡因加5 μg/mL肾上腺素）和阻滞辅助剂（4 mg静脉注射地塞米松）相同。术后，所有患者在48小时内接受患者自控静脉镇痛（吗啡）以及对乙酰氨基酚和酮洛芬。
一名盲法研究者记录24小时和48小时的吗啡消耗量、首次要求使用吗啡的时间、3、6、12、24和48小时的疼痛评分、不良事件发生率、准备出院时间和住院时间。盲法研究者还在3、6和24小时使用10分制感觉运动综合量表进行感觉运动阻滞评估。
在24小时（95%CI：-4.0 mg至2.0 mg）和48小时（95%CI，-5.0 mg至2.0 mg）的累积吗啡消耗量或首次要求使用吗啡的时间方面，未发现组间差异。此外，3小时后的所有时间间隔疼痛评分相似。在3和6小时的感觉运动综合评分方面，未发现组间差异。然而，SIFIB持续时间比腰丛阻滞更长，24小时时的综合评分更高即证明了这一点。在并发症方面未发现组间差异。与LPB相比，SIFIB与更短的准备出院时间（3[1 - 4]天对2[1 - 3]天；P = 0.042）和住院时间（3[2 - 5]天对3[2 - 4]天；P = 0.048）相关。
对于THA，LPB和SIFIB在突破性吗啡需求和疼痛控制方面未发现差异。然而，SIFIB导致阻滞时间更长，且与更短的准备出院时间以及缩短的住院时间相关。
