超声引导下囊周神经群阻滞联合髂筋膜间隙阻滞用于髋部骨折手术的镇痛效果：一项前瞻性随机对照试验。
The Analgesic effect of adding ultrasound-guided pericapsular nerve group block to suprainguinal fascia iliaca compartment block for hip fracture surgery: A prospective randomized controlled trial.
机构信息
Department of Anesthesiology, Buddhachinaraj Hospital, Phitsanulok, Thailand.
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Medicine (Baltimore). 2023 Nov 3;102(44):e35649. doi: 10.1097/MD.0000000000035649.
BACKGROUND
Both suprainguinal ultrasound-guided fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block have been used to treat pain after hip surgery. Motor-sparing PENG block may further expedite early postoperative rehabilitation. This study aimed to compare the analgesic efficacy and recovery outcome of suprainguinal ultrasound-guided FICB alone with FICB combined with PENG block for hip fracture surgery.
METHODS
In this study, 59 elderly patients undergoing hip fracture surgery were randomized to receive either FICB alone or combined FICB + PENG block. The primary outcome was pain score at rest 12 hours after surgery as measured by the numerical rating scale (NRS, 0-10) and secondary outcomes were pain scores at rest and with movement measured at other time points within 48 hours, time to first sit up without pain, rescue morphine requirements, opioid-related side effects, incidence of delirium, in-hospital morbidities and mortality, and length of hospital stay.
RESULTS
Both patient groups had similar demographic profile and postoperative pain scores at rest and with movement. Median NRS pain scores at rest between FICB alone or combined FICB + PENG block at 4, 8, 12, 24, 36 and 48 hours after surgery were 3 versus 3 (P = .31), 3 versus 3 (P = .21) and 3 versus 3 (P = .69), 2 versus 2 (P = .35), 2 versus 3 (P = .17), 3 versus 2 (P = .18) respectively and NRS during movement at 12, 24, 48 hours were 10 versus 8 (P = .30), 6 versus 5 (P = .54) and 3.5 versus 2.0 (P = .64), respectively. There was also no significant difference in the time for patients to first sit up without pain (17.50 vs 19.37 hours vs h; P = .058) or any other secondary outcome measures. The procedure time was, however, significantly longer for the FICB + PENG block (10 vs 5 minutes, P < .001).
CONCLUSION
Addition of ultrasound-guided PENG block to FICB did not improve postoperative analgesic or recovery outcomes in elderly patients undergoing hip fracture surgery.
背景
在髋关节手术后，人们既可以采用经超声引导的髂筋膜间隙阻滞（FICB），也可以采用囊周神经群阻滞（PENG）来缓解疼痛。为了促进患者术后早期康复，人们可以采用保留运动功能的 PENG 阻滞。本研究旨在比较单纯经超声引导的 FICB 与 FICB 联合 PENG 阻滞对髋部骨折手术的镇痛效果和恢复结果。
方法
本研究中，59 名接受髋部骨折手术的老年患者被随机分为接受单纯 FICB 或 FICB 联合 PENG 阻滞的组。主要结局是术后 12 小时内静息状态下的疼痛评分，采用数字评分量表（NRS，0-10）进行测量；次要结局是术后 48 小时内其他时间点的静息和运动时的疼痛评分、首次无痛坐起时间、需要解救性吗啡的次数、阿片类药物相关的副作用、谵妄发生率、住院期发病率和死亡率，以及住院时间。
结果
两组患者的人口统计学特征和术后静息及运动时的疼痛评分均相似。单纯 FICB 或 FICB 联合 PENG 阻滞的患者，在术后 4、8、12、24、36 和 48 小时的静息状态下 NRS 疼痛评分中位数分别为 3 分比 3 分（P=0.31）、3 分比 3 分（P=0.21）和 3 分比 3 分（P=0.69）、2 分比 2 分（P=0.35）、2 分比 3 分（P=0.17）和 3 分比 2 分（P=0.18）；在运动时的 NRS 疼痛评分中位数分别为 10 分比 8 分（P=0.30）、6 分比 5 分（P=0.54）和 3.5 分比 2.0 分（P=0.64）。首次无痛坐起时间（17.50 小时比 19.37 小时，P=0.058）或其他任何次要结局指标也没有显著差异。但是，FICB+PENG 阻滞的操作时间显著更长（10 分钟比 5 分钟，P<0.001）。
结论
在髋部骨折手术患者中，FICB 联合超声引导的 PENG 阻滞并不能改善术后镇痛或恢复效果。
Zotero 插件