Wyatt Karla, Zidane Moustafa, Liu Chyong-Jy Joyce
Department of Anesthesiology, Perioperative and Pain Management, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Case Rep Orthop. 2020 Jul 14;2020:2516578. doi: 10.1155/2020/2516578. eCollection 2020.
In the pediatric population, femoral neck fractures are usually associated with high-impact trauma and often present with pain in the groin area. Regional anesthesia can offer adjunctive therapy for acute pain management. Various techniques have been employed to circumvent pain related to hip fractures and resultant hip surgery. Neuraxial, lumbar plexus, caudal, epidural, fascia iliaca, and femoral continuous nerve block techniques are advantageous in mitigating hip pain. However, these approaches require patient repositioning during placement and carry the potential for motor blockade with resultant weakness. A newly described method, the Pericapsular Nerve Group (PENG) block, allows for analgesia of the anterior hip capsule via the obturator, accessory obturator, and femoral nerves while sparing motor blockade. PENG blockade has demonstrated efficacy in both adult and pediatric patients. Herein, we describe the perioperative course of a 9-year-old girl with a transcervical femoral neck fracture who underwent an opioid-sparing open repair with the utilization of a continuous PENG block. PENG blockade via a continuous nerve block resulted in optimal analgesia and markedly reduced perioperative opioid consumption with preserved motor function. Our experience facilitated early discharge and rehabilitation mobility while reducing potential rebound hyperalgesia and enabling parental/patient satisfaction.
在儿科人群中，股骨颈骨折通常与高能量创伤相关，常表现为腹股沟区疼痛。区域麻醉可为急性疼痛管理提供辅助治疗。已采用多种技术来规避与髋部骨折及由此导致的髋部手术相关的疼痛。神经轴阻滞、腰丛阻滞、骶管阻滞、硬膜外阻滞、髂筋膜阻滞和股神经连续阻滞技术在减轻髋部疼痛方面具有优势。然而，这些方法在操作过程中需要患者重新摆放体位，且存在导致运动阻滞及随之而来的肌无力的可能性。一种新描述的方法，即关节囊周围神经群（PENG）阻滞，可通过闭孔神经、闭孔副神经和股神经实现对髋关节前关节囊的镇痛，同时避免运动阻滞。PENG阻滞已在成人和儿科患者中均显示出疗效。在此，我们描述了一名9岁经颈型股骨颈骨折女孩的围手术期过程，该女孩在连续PENG阻滞的情况下接受了减少阿片类药物用量的开放性修复手术。通过连续神经阻滞进行PENG阻滞可实现最佳镇痛效果，显著减少围手术期阿片类药物用量，同时保留运动功能。我们的经验促进了早期出院和康复活动，同时减少了潜在的痛觉过敏反弹，并提高了家长/患者的满意度。
