全髋关节置换术围囊神经组（PENG）阻滞术后的疼痛管理与功能恢复：一项前瞻性、随机、双盲临床试验

Pain Management and Functional Recovery after Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty: A Prospective, Randomized, Double-Blinded Clinical Trial.

作者信息

Domagalska Małgorzata, Ciftci Bahadir, Reysner Tomasz, Kolasiński Jerzy, Wieczorowska-Tobis Katarzyna, Kowalski Grzegorz

机构信息

Department of Palliative Medicine, University of Medical Sciences, 61-245 Poznan, Poland.

Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul 34214, Turkey.

出版信息

J Clin Med. 2023 Jul 27;12(15):4931. doi: 10.3390/jcm12154931.

BACKGROUND

The immediate postoperative period after total hip arthroplasty can be associated with significant pain. Therefore, this study aimed to evaluate the effect of pericapsular nerve block on pain management and functional recovery after total hip arthroplasty.

METHODS

This prospective, randomized, double-blinded, placebo-controlled trial was conducted on 489 adult patients scheduled for total hip arthroplasty, ASA 1-2, operated under spinal analgesia. Participants were assigned to receive either a pericapsular nerve group (PENG) block with 20 mL of 0.5% ropivacaine or a sham block.

RESULTS

The primary outcome measure was the postoperative NRS score in motion. The secondary outcomes were cumulative opioid consumption, the time to the first opioid, and functional recovery. Demographic characteristics were similar in both groups. Intraoperative pain scores were significantly lower in patients who received the PENG block than in the control group ( < 0.0001). Also, the time to the first opioid was considerably longer in the PENG group ( < 0.0001). Additionally, 24% of PENG patients did not require opioids ( < 0.0001).

CONCLUSIONS

The pericapsular nerve group showed significantly decreased opioid consumption and improved functional recovery. Pericapsular nerve group block improved pain management and postoperative functional recovery following total hip arthroplasty.

背景

全髋关节置换术后的即刻术后阶段可能伴有显著疼痛。因此，本研究旨在评估关节周围神经阻滞对全髋关节置换术后疼痛管理和功能恢复的影响。

方法

本前瞻性、随机、双盲、安慰剂对照试验纳入了489例计划行全髋关节置换术的成年患者，美国麻醉医师协会（ASA）分级为1-2级，采用脊髓镇痛进行手术。参与者被分配接受20毫升0.5%罗哌卡因的关节周围神经阻滞组（PENG）或假阻滞。

结果

主要结局指标是术后活动时的数字评分量表（NRS）评分。次要结局包括累积阿片类药物消耗量、首次使用阿片类药物的时间和功能恢复情况。两组的人口统计学特征相似。接受PENG阻滞的患者术中疼痛评分显著低于对照组（<0.0001）。此外，PENG组首次使用阿片类药物的时间明显更长（<0.0001）。此外，24%的PENG组患者不需要使用阿片类药物（<0.0001）。