比较髋关节周围神经组阻滞与腰丛阻滞用于髋部骨折手术:一项单中心随机双盲研究。
Comparing the Pericapsular Nerve Group Block and the Lumbar Plexus Block for Hip Fracture Surgery: A Single-Center Randomized Double-Blinded Study.
作者信息
Lee Tae Young, Chung Chan Jong, Park Sang Yoong
机构信息
Department of Anaesthesiology and Pain Medicine, College of Medicine, Dong-A University, Busan 49201, Republic of Korea.
出版信息
J Clin Med. 2023 Dec 25;13(1):122. doi: 10.3390/jcm13010122.
Lumbar plexus blocks (LPBs) are routinely employed for analgesia in hip fracture surgery; however, a novel regional technique, the pericapsular nerve group (PENG) block, potentially offers comparable pain reduction while preserving motor function. Patients aged 45-90 years who underwent hip fracture surgery were allocated to receive either a PENG block or an LPB for analgesia. The primary outcome was the incidence of quadriceps motor block (defined as the paresis or paralysis of the knee extension) at 12 h postoperatively. The secondary outcomes included the performance time, the time to first analgesic requirement, postoperative intravenous (IV) fentanyl consumption, the ability to undergo physiotherapy at 24 and 48 h, complications, sensory and motor block assessments, postoperative numeric rating scale (NRS) pain scores, and patient outcome questionnaires. There was a significantly lower incidence of quadriceps motor block at 6 h (26.7% vs. 80.0%; < 0.001) and at 12 h (20.0% vs. 56.7%; = 0.010). The PENG block provided better preservation of the sensory block as well as better performance time ( < 0.001) and time to first analgesia requirement ( = 0.034), whereas the LPB resulted in lower postoperative IV fentanyl consumption at 24 h ( = 0.013). The PENG block demonstrated superiority over the LPB in preserving quadriceps strength and patient satisfaction without any substantial complications, despite higher opioid consumption within the first 24 h post-surgery.
腰丛阻滞(LPBs)常用于髋部骨折手术的镇痛;然而,一种新型区域技术——关节周围神经群(PENG)阻滞,可能在减轻疼痛的同时保留运动功能。年龄在45至90岁之间接受髋部骨折手术的患者被分配接受PENG阻滞或LPB进行镇痛。主要结局是术后12小时股四头肌运动阻滞的发生率(定义为膝关节伸展无力或麻痹)。次要结局包括操作时间、首次需要镇痛的时间、术后静脉注射(IV)芬太尼的用量、术后24小时和48小时进行物理治疗的能力、并发症、感觉和运动阻滞评估、术后数字评分量表(NRS)疼痛评分以及患者结局问卷。在6小时(26.7%对80.0%;<0.001)和12小时(20.0%对56.7%;=0.010)时,股四头肌运动阻滞的发生率显著更低。PENG阻滞在感觉阻滞的保留方面以及操作时间(<0.001)和首次需要镇痛的时间(=0.034)方面表现更好,而LPB导致术后24小时静脉注射芬太尼的用量更低(=0.013)。尽管术后24小时内阿片类药物用量更高,但PENG阻滞在保留股四头肌力量和患者满意度方面优于LPB,且无任何严重并发症。