Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile.
Reg Anesth Pain Med. 2021 Oct;46(10):874-878. doi: 10.1136/rapm-2021-102997. Epub 2021 Jul 20.
This randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%.
Forty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours.
Compared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; p<0.001) and 6 hours (25% vs 85%; p<0.001). Furthermore, pericapsular nerve group block also provided better preservation of hip adduction at 3 hours (p=0.023) as well as decreased sensory block of the anterior, lateral, and medial thighs at all measurement intervals (all p≤0.014). No clinically significant intergroup differences were found in terms of postoperative pain scores, cumulative opioid consumption at 24 and 48 hours, ability to perform physiotherapy, opioid-related side effects, and length of hospital stay.
For primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration.
NCT04402450.
本随机试验比较了超声引导下囊周神经群阻滞和股外侧筋膜髂骨阻滞在初次全髋关节置换术患者中的效果。我们选择术后 6 小时股四头肌运动阻滞（定义为膝伸展无力或瘫痪）的发生率作为主要结局。我们假设与股外侧筋膜髂骨阻滞相比，囊周神经群阻滞可将其发生率从 70%降低至 20%。
40 例在脊髓麻醉下接受初次全髋关节置换术的患者被随机分配接受囊周神经群阻滞（n=20），使用 20 mL 含肾上腺素左旋布比卡因 0.50%；或接受股外侧筋膜髂骨阻滞（n=20），使用 40 mL 含肾上腺素左旋布比卡因 0.25%。在完成阻滞操作后，一位盲法观察者记录 3、6、12、18、24、36 和 48 小时的疼痛评分；24 和 48 小时累积突破性吗啡消耗量；阿片类药物相关副作用；24 和 48 小时行物理治疗的能力；以及住院时间。此外，盲法观察者还在 3、6 和 24 小时进行感觉评估（大腿中部前、侧和内侧）和运动评估（膝伸展和髋关节内收）。
与股外侧筋膜髂骨阻滞相比，囊周神经群阻滞在 3 小时（45% vs 90%；p<0.001）和 6 小时（25% vs 85%；p<0.001）时股四头肌运动阻滞的发生率较低。此外，囊周神经群阻滞还可在 3 小时时更好地保留髋关节内收（p=0.023），并在所有测量间隔降低大腿前、侧和内侧的感觉阻滞（均 p≤0.014）。两组在术后疼痛评分、24 和 48 小时累积阿片类药物消耗、行物理治疗的能力、阿片类药物相关副作用和住院时间方面无明显的临床差异。
对于初次全髋关节置换术，囊周神经群阻滞在保留运动功能方面优于股外侧筋膜髂骨阻滞。需要进一步研究来阐明运动保留型囊周神经群阻滞的最佳局部麻醉药容量，并将其与关节周围局部麻醉浸润等其他运动保留策略进行比较。
NCT04402450。
