Marrone Francesco, Fusco Pierfrancesco, Tulgar Serkan, Paventi Saverio, Tomei Marco, Fabbri Fabio, Iacovazzi Michele, Pullano Carmine
Anesthesiology, Santo Spirito Hospital, Rome, ITA.
Anesthesiology and Intensive Care Unit, San Filippo e Nicola Hospital, Avezzano, ITA.
Cureus. 2024 Feb 7;16(2):e53815. doi: 10.7759/cureus.53815. eCollection 2024 Feb.
A hip fracture is a serious injury with life-threatening complications, and its risk rises with increasing age. A hip fracture can be a very painful condition, and prompt surgical treatment is recommended to reduce pain and complications. Pain management is considered integral to the management of a broken hip. The choice between general and regional anesthesia in hip fracture surgery continues to be a topic of debate because risks are potentially associated with both approaches. Nerve blockades have proven to be effective in reducing acute pain after a hip fracture and in the perioperative period. For this reason, many regional techniques have been introduced, such as the lumbar plexus block, fascia iliac block, femoral nerve block, and recently, the pericapsular nerve group (PENG) block. Hip joint innervation is complex, not limited to the lumbar plexus but also depending on the sciatic nerve and branches of the sacral plexus (superior and inferior gluteal nerves and an articular branch from the quadratus femoris nerve). We hypothesized that a combination of two emerging regional anesthesia techniques, such as the PENG block and sacral erector spinae plane (S-ESP) block, could represent a good option to obtain pain control of the whole hip joint without opioid administration intraoperatively and postoperatively. Here, we report the cases of three frail patients with significant comorbidities who underwent hip fracture surgery (two cases of intramedullary nailing and one hemiarthroplasty), in which we preoperatively performed PENG and S-ESP blocks. We registered optimal intraoperative and postoperative pain control up to 48 hours after surgery without complications and without opioid administration, allowing the surgery to be performed with intravenous sedation or laryngeal mask general anesthesia. The surgeries were uneventful, and no complications were reported. This approach warrants further investigation in hip fracture surgery.
髋部骨折是一种伴有危及生命并发症的严重损伤，其风险随年龄增长而增加。髋部骨折会带来非常疼痛的状况，建议进行及时的手术治疗以减轻疼痛和并发症。疼痛管理被认为是髋部骨折治疗不可或缺的一部分。髋部骨折手术中全身麻醉和区域麻醉的选择仍然是一个有争议的话题，因为两种方法都可能存在风险。神经阻滞已被证明在减轻髋部骨折后及围手术期的急性疼痛方面是有效的。因此，已经引入了许多区域技术，如腰丛阻滞、髂筋膜阻滞、股神经阻滞，以及最近的关节周围神经群（PENG）阻滞。髋关节的神经支配很复杂，不仅限于腰丛，还依赖于坐骨神经和骶丛的分支（臀上神经和臀下神经以及股方肌神经的一个关节支）。我们假设，两种新兴的区域麻醉技术联合使用，如PENG阻滞和骶棘肌平面（S-ESP）阻滞，可能是在术中及术后不使用阿片类药物的情况下实现整个髋关节疼痛控制的一个好选择。在此，我们报告了3例患有严重合并症的体弱患者接受髋部骨折手术的病例（2例髓内钉固定和1例半髋关节置换术），我们在术前进行了PENG阻滞和S-ESP阻滞。我们记录到术后48小时内术中及术后疼痛控制良好，无并发症且未使用阿片类药物，手术可在静脉镇静或喉罩全身麻醉下进行。手术过程顺利，未报告并发症。这种方法值得在髋部骨折手术中进一步研究。
