Department of Anesthesia and Intensive Care, Assiut University Hospital, Assiut, Egypt.
Department of Orthopedic Surgery and Traumatology, Assiut University Hospital, Assiut, Egypt.
Pain Physician. 2023 Jul;26(4):357-367.
Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is associated with increased patient satisfaction, earlier mobilization, and decreased opioid consumption.
Therefore, there is a need for safe, reliable, and opioid- and motor-sparing methods of achieving postoperative analgesia following hip arthroscopy. We evaluated the efficacy of pericapsular nerve group (PENG) block vs fascia iliaca block (FIB) in reducing postoperative pain and analgesic consumption in the first 24 hours following hip arthroscopy.
A prospective randomized double-blinded control clinical trial.
At the arthroscopy unit of the orthopedic department of Assiut University Hospitals, Assiut, Egypt from 2019 to 2022.
Forty-three patients comprising 18 women and 25 men scheduled for hip arthroscopy were randomized to receive a preoperative block with PENG or FIB from March 2019 to March 2022. The mean age was 27.9 years (standard deviation [SD], 6.2 years; range, 18-42 years) and the mean body mass index was 25.13 kg/m2 (SD, 5.08 kg/m2). Patients were randomized into 2 groups: group A comprising 20 patients that received FIB; and group B comprising 23 patients that received PENG block. The efficacies of FIB and PENG block were evaluated using Visual Analog Scale scores.
Statistically significant differences in median pain scores and mean at rest pain scores were observed between the 2 groups at all measured time points following surgery (i.e., 6, 12, 18, and 24 hours). Further, dynamic pain scores (with hip flexion) scores significantly differed between the 2 groups at 24 hours postoperatively (P = 0.001). PENG block significantly decreased postoperative opioid use compared to FIB. Total opioid use in the 24-hour postoperative period was lower in the PENG group compared to the FIB group (16.5 ± 9.9 vs 27.5 ± 9.6; P < 005).
Different hip pathologies and different interventions lead to different outcomes. Also, a larger sample size and longer follow-up duration are required.
PENG block may represent the ideal regional anesthesia modality for hip arthroscopy as an alternative to more conventional regional nerve blocks, such as FIB, femoral nerve block, and lumbar plexus block. PENG block is reproducible, easily performed in the preoperative setting, and appears to spare motor function while providing prolonged sensory analgesia.
髋关节镜术后疼痛仍然是患者术后即刻不满意的主要原因。充分的术后镇痛与增加患者满意度、更早的活动和减少阿片类药物的消耗有关。
因此，需要安全、可靠且不使用阿片类药物和保留运动功能的方法来实现髋关节镜术后的术后镇痛。我们评估了囊周神经群（PENG）阻滞与股神经阻滞（FIB）在减少髋关节镜术后 24 小时内术后疼痛和阿片类药物消耗方面的效果。
前瞻性随机双盲对照临床试验。
2019 年至 2022 年在埃及阿西尤特大学医院骨科关节镜病房进行。
43 名患者（18 名女性和 25 名男性）被随机分为接受术前 PENG 或 FIB 阻滞的两组，分别于 2019 年 3 月至 2022 年 3 月进行髋关节镜手术。平均年龄为 27.9 岁（标准差[SD]，6.2 岁；范围，18-42 岁），平均体重指数为 25.13 kg/m2（SD，5.08 kg/m2）。患者被随机分为 2 组：A 组 20 例接受 FIB；B 组 23 例接受 PENG 阻滞。使用视觉模拟评分法（VAS）评估 FIB 和 PENG 阻滞的疗效。
与手术后所有测量时间点（即 6、12、18 和 24 小时）相比，两组的中位数疼痛评分和静息时平均疼痛评分均存在统计学显著差异。进一步，术后 24 小时两组之间的动态疼痛评分（髋关节屈曲时）差异显著（P = 0.001）。与 FIB 相比，PENG 阻滞显著减少了术后阿片类药物的使用。术后 24 小时内 PENG 组的总阿片类药物用量明显低于 FIB 组（16.5±9.9 vs 27.5±9.6；P<005）。
不同的髋关节疾病和不同的干预措施导致不同的结果。此外，需要更大的样本量和更长的随访时间。
与更传统的区域神经阻滞（如 FIB、股神经阻滞和腰丛阻滞）相比，PENG 阻滞可能是髋关节镜手术的理想区域麻醉方式。PENG 阻滞可重复，易于在术前进行，且似乎保留运动功能的同时提供长时间的感觉镇痛。
