Rocha-Romero A, Arias-Mejia K, Salas-Ruiz A, Peng P W H
Department of Anaesthesia and Pain Medicine Hospital de Trauma Centro Nacional de Rehabilitación San José Costa Rica.
Department of Emergency Medicine Hospital San Vicente de Paúl Heredia Costa Rica.
Anaesth Rep. 2021 May 18;9(1):97-100. doi: 10.1002/anr3.12118. eCollection 2021 Jan-Jun.
Guidelines for the management of hip fractures recommend timely identification, analgesia and optimisation, in order to facilitate prompt surgical repair. In achieving these aims, multidisciplinary care is essential. In this case series, we present five patients who received bedside pericapsular nerve group (PENG) blocks by emergency physicians in collaboration with the anaesthesia team for pain management following hip fracture. The PENG block is a novel motor- and opioid-sparing technique, which offers long-lasting analgesia and requires less volume than other blocks. In all of the cases in this series, the blocks were performed successfully in a short period of time, without complication. All patients reported a clinically important reduction in pain scores. Patients with hip fracture are often medically complex, and while early surgery is not always possible, pain management should be addressed from an early point in their hospital admission. Multidisciplinary input into peri-operative pathways can enhance the provision of analgesia in the emergency department, by allowing anaesthetists and emergency physicians to work together for the benefit of these often-frail patients.
髋部骨折管理指南建议及时识别、镇痛和优化治疗,以促进及时的手术修复。为实现这些目标,多学科护理至关重要。在本病例系列中,我们介绍了五名患者,他们在髋部骨折后由急诊医生与麻醉团队合作接受了床边关节囊周围神经组(PENG)阻滞以进行疼痛管理。PENG阻滞是一种新型的保留运动和阿片类药物的技术,可提供持久的镇痛效果,且所需剂量比其他阻滞更少。在本系列的所有病例中,阻滞均在短时间内成功完成,无并发症发生。所有患者均报告疼痛评分有临床意义的降低。髋部骨折患者通常病情复杂,虽然早期手术并非总是可行,但疼痛管理应在他们入院早期就加以解决。通过让麻醉师和急诊医生共同努力为这些通常体弱的患者谋福利,多学科参与围手术期路径可以加强急诊科的镇痛措施。