Gupta Nishu, Das Samaresh, Chatterjee Nilay, Munjal Manish
Trauma and Orthopaedics, Yeovil District Hospital, Yeovil, GBR.
Anaesthesia, Yeovil District Hospital, Yeovil, GBR.
Cureus. 2022 Dec 14;14(12):e32515. doi: 10.7759/cureus.32515. eCollection 2022 Dec.
Background Severe postoperative pain and immobility increase the length of hospital stay and immobility-related life-threatening complications after total hip replacement (THR). Pericapsular nerve group (PENG) block is a recent addition to pain management of neck of femur (NoF) fracture, the use of which has been incorporated into THR as alternative analgesia or as an adjunct with other regional analgesia techniques. The present study primarily aims to assess postoperative mobility. Secondary outcomes measured were the length of hospital stay, pain score, opioid consumption, and side effects. Methods This is a retrospective study of 50 patients who underwent primary THR. Twenty-eight patients received PENG block after spinal anesthesia (PENG Group), seven patients had general anesthesia (GA) with patient-controlled analgesia (PCA) postoperatively (PCA Group), and the remaining 15 received spinal anesthesia with fascia iliaca block (FIB Group). Mobilization was attempted in all patients (ability to stand and walk a few steps with a walker) 10 hours after the end of surgery. Data was collected for average postoperative pain score, time of mobilization, total opioid consumption (till discharge from the hospital), opioid-related side effects, and time of discharge. Results Mobilization was attempted in all patients 10 hours after the end of the surgery, irrespective of their anesthetic technique. In the PENG Group, 26 patients (n=28) could be mobilized after the first 10 hours without opioids. The total morphine requirement until discharge was significantly less in the PENG Group of patients compared to the FIB and GA+PCA patients. The average time of discharge (hours) from the hospital (22.1+/-4.9) was also significantly lower in the PENG Group compared to all other groups (31.7 +/- 3.4, p=<0.01). The average postoperative pain score was significantly low in the PENG Group within the first 48 hours. Conclusion The PENG block helps in early mobilization and enhanced recovery after THR.
全髋关节置换术（THR）后严重的术后疼痛和活动受限会延长住院时间，并增加与活动受限相关的危及生命的并发症。关节周围神经组（PENG）阻滞是股骨颈（NoF）骨折疼痛管理中的一项新方法，其已被纳入THR，作为替代镇痛方法或与其他区域镇痛技术联合使用。本研究主要旨在评估术后活动能力。次要测量结果包括住院时间、疼痛评分、阿片类药物消耗量和副作用。方法：这是一项对50例行初次THR患者的回顾性研究。28例患者在脊髓麻醉后接受PENG阻滞（PENG组），7例患者接受全身麻醉（GA）并在术后使用患者自控镇痛（PCA）（PCA组），其余15例接受脊髓麻醉联合髂筋膜阻滞（FIB组）。所有患者在手术结束后10小时尝试进行活动（使用助行器站立并行走几步的能力）。收集术后平均疼痛评分、活动时间、总阿片类药物消耗量（直至出院）、阿片类药物相关副作用及出院时间的数据。结果：所有患者在手术结束后10小时均尝试进行活动，无论其麻醉技术如何。在PENG组中，26例患者（n = 28）在最初10小时后无需使用阿片类药物即可活动。与FIB组和GA + PCA组患者相比，PENG组患者直至出院时的总吗啡需求量显著更低。与所有其他组（31.7 +/- 3.4，p =<0.01）相比，PENG组患者的平均出院时间（小时）（22.1 +/- 4.9）也显著更短。PENG组在术后48小时内的平均术后疼痛评分显著更低。结论：PENG阻滞有助于THR后的早期活动和加速康复。
