ARCUS Sportklinik, Pforzheim, Germany.
MVZ Praxisklinik Orthopädie Aachen, University of Aachen, Aachen, Germany; University Witten/Herdecke, Witten, Germany.
Arthroscopy. 2024 Feb;40(2):373-380. doi: 10.1016/j.arthro.2023.06.016. Epub 2023 Jun 22.
To investigate whether the use of a pericapsular nerve group (PENG) block would reduce perioperative pain after arthroscopic therapy for femoroacetabular impingement syndrome (FAIS) and to examine opioid requirements and occurrence of postoperative nausea and vomiting (PONV).
Between May 2022 and October 2022, patients (N = 68) undergoing arthroscopic surgery for FAIS were randomly allocated into 2 groups. The first group received an ultrasound-guided PENG preoperatively with 20 mL of 0.375% ropivacaine and standardized postoperative oral medication. The second group received a sham block preoperatively with 20 mL of 0.9% saline and standardized postoperative oral medication. The primary end point was pain scores (visual analog score [VAS], 0-10) during the first 24 hours postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the minimal clinically important difference (MCID) was calculated using the half standard deviation method. The incidence of PONV as well as opioid usage (converted to morphine equivalent) within the first 24 hours were secondary outcomes.
Randomization and permission were successfully obtained from 68 participants. From the fifteenth postoperative hour, the PENG group reported significantly less postoperative pain than the control group (24th postoperative hour: VAS pain PENG group 1.3 ± 0.9 [0-3]; 95% confidence interval {CI} 0.4-1.2 vs the VAS pain control group 2.4 ± 1.6 [0-5]; 95% CI 1.4-4.7; P = .009). The VAS pain score threshold for achieving the MCID at 24 hours postoperative was defined as a decrease of 1.1. 27 patients (79%) in the PENG group and 22 patients (65%) in the control group were able to achieve MCID (P = .009). Opioid dosage and postoperative nausea did not differ significantly between groups (P = .987 and P = .655, respectively). Concomitant complications such as falls, hematomas, or weakened muscles did not occur in either group.
According to this study, a PENG block minimally reduced pain after arthroscopic treatment for FAIS between the 18th and 24th postoperative hours. The PENG group achieved significantly more often the pain VAS MCID. However, there was no proof that the PENG group consumed fewer opioids than the control group. Overall, PONV was found at a low and comparable rate.
Level I, randomized controlled trial.
探讨关节囊周围神经群（PENG）阻滞是否会减少髋关节撞击综合征（FAIS）关节镜治疗后的围手术期疼痛，并检查阿片类药物的需求以及术后恶心和呕吐（PONV）的发生情况。
2022 年 5 月至 2022 年 10 月，对 68 例接受 FAIS 关节镜手术的患者进行了随机分组。第一组在术前接受超声引导下的 PENG 阻滞，注射 20 毫升 0.375%罗哌卡因，并给予标准化的术后口服药物。第二组在术前接受假阻滞，注射 20 毫升 0.9%生理盐水，并给予标准化的术后口服药物。主要终点是术后 24 小时内的疼痛评分（视觉模拟评分 [VAS]，0-10）。为了量化 VAS 疼痛评分达到临床意义的结果，使用半标准差法计算最小临床重要差异（MCID）。PONV 的发生率以及术后 24 小时内阿片类药物的使用量（换算成吗啡当量）是次要结果。
从 68 名参与者中成功获得了随机化和同意。从术后第 15 小时开始，PENG 组报告的术后疼痛明显少于对照组（术后第 24 小时：PENG 组 VAS 疼痛 1.3±0.9[0-3]；95%置信区间 [CI]0.4-1.2 与 VAS 疼痛对照组 2.4±1.6[0-5]；95%CI1.4-4.7；P=0.009）。术后 24 小时达到 MCID 的 VAS 疼痛评分阈值定义为降低 1.1。27 名（79%）PENG 组患者和 22 名（65%）对照组患者能够达到 MCID（P=0.009）。两组之间的阿片类药物剂量和术后恶心没有显著差异（P=0.987 和 P=0.655）。两组均未发生跌倒、血肿或肌肉无力等伴随并发症。
根据这项研究，PENG 阻滞可在 FAIS 关节镜治疗后 18 至 24 小时内轻微减轻疼痛。PENG 组更经常达到 VAS 疼痛 MCID。然而，没有证据表明 PENG 组比对照组使用的阿片类药物更少。总体而言，PONV 的发生率较低且相当。
I 级，随机对照试验。
