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比较研究:评估超声引导下关节周围神经群阻滞与髂筋膜间隙阻滞对脊髓麻醉下行髋部骨折手术患者术后镇痛效果的影响

Comparative Study to Evaluate the Effect of Ultrasound-Guided Pericapsular Nerve Group Block Versus Fascia Iliaca Compartment Block on the Postoperative Analgesic Effect in Patients Undergoing Surgeries for Hip Fracture under Spinal Anesthesia.

作者信息

Natrajan Pratheeba, Bhat Ravindra Rahuveera, Remadevi R, Joseph Idhuyya Raajesh, Vijayalakshmi S, Paulose T Deepak

机构信息

Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India.

出版信息

Anesth Essays Res. 2021 Jul-Sep;15(3):285-289. doi: 10.4103/aer.aer_122_21. Epub 2022 Feb 7.

Abstract

BACKGROUND

Fractures in and around the hip are a major concern in young as well as the elderly. Ultrasound-guided (USG) peripheral nerve blocks help in early surgical fixation of these fractures by providing perioperative pain relief as well as early mobilization resulting in reduced morbidity and mortality.

AIMS

This study aims to compare the efficacy of USG pericapsular nerve group (PENG) block versus fascia iliaca compartment (FIC) block.

SETTING AND DESIGN

Prospective, randomized, double-blind, controlled study.

MATERIALS AND METHODS

Twenty-four patients above 18 years of age with hip fracture belonging to the American Society of Anaesthesiologists physical status Classes I and II scheduled for hip surgery were randomly allocated into two groups. Group 1(PENG block) received USG-guided PENG block and Group 2 (FIC block) received USG guided FIC block for postoperative pain relief. Postoperative pain relief (at rest) was evaluated by Numeric Rating Scale score from 20 min and at regular interval for 24 h. The total analgesic consumption in the first 24 h was also noted.

STATISTICAL ANALYSIS USED

Data were analyzed by using nonparametric test and Chi-square test. Hemodynamic variables and pain scores were analyzed using analysis of variance for two groups and independent -test was used for comparison between two groups.

RESULTS

Postoperative NRS score was higher in FIC block than PENG block which was statistically significant at 1 h ( = 0.035) and at 4 h ( = 0.001). The first requirement of analgesic was significantly late in PENG block group (8.17 ± 3.129) as compared to FIC block group (4.00 ± 1.477).

CONCLUSIONS

PENG block provides better postoperative analgesia, with reduced requirement of rescue analgesics in 24 h as compared to FIC block in patients undergoing surgeries for hip fracture under spinal anesthesia.

摘要

背景

髋部及其周围骨折是年轻人和老年人都主要关注的问题。超声引导(USG)外周神经阻滞通过提供围手术期疼痛缓解以及早期活动,有助于这些骨折的早期手术固定,从而降低发病率和死亡率。

目的

本研究旨在比较超声引导下关节囊周围神经组(PENG)阻滞与髂筋膜间隙(FIC)阻滞的疗效。

设置与设计

前瞻性、随机、双盲、对照研究。

材料与方法

将24例年龄在18岁以上、计划进行髋关节手术、美国麻醉医师协会身体状况分级为I级和II级的髋部骨折患者随机分为两组。第1组(PENG阻滞组)接受超声引导下的PENG阻滞,第2组(FIC阻滞组)接受超声引导下的FIC阻滞以缓解术后疼痛。术后静息时的疼痛缓解情况通过数字评分量表在术后20分钟及之后24小时定期进行评估。同时记录前24小时的总镇痛药物消耗量。

所用统计分析方法

数据采用非参数检验和卡方检验进行分析。两组的血流动力学变量和疼痛评分采用方差分析进行分析,两组间比较采用独立样本t检验。

结果

FIC阻滞组术后数字评分量表(NRS)评分高于PENG阻滞组,在术后1小时(P = 0.035)和4小时(P = 0.001)具有统计学意义。与FIC阻滞组(4.00±1.477)相比,PENG阻滞组首次需要镇痛药物的时间明显延迟(8.17±3.129)。

结论

在脊髓麻醉下接受髋部骨折手术的患者中,与FIC阻滞相比,PENG阻滞提供了更好的术后镇痛效果,且24小时内补救性镇痛药物的需求量减少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/003f/8936861/db5fa2ad9a76/AER-15-285-g001.jpg

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