Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
Rev Esp Anestesiol Reanim (Engl Ed). 2024 Mar;71(3):160-170. doi: 10.1016/j.redare.2024.02.011. Epub 2024 Feb 12.
Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions.
The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest.
In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block.
A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases).
This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.
全髋关节置换术是医院中最常见的手术干预之一。然而，管理术后疼痛的理想方法仍不清楚。基于区域麻醉的多模式镇痛技术是最有前途的解决方案之一。
本研究旨在评估全髋关节置换术后是否进行外周神经阻滞（股神经阻滞、髂筋膜阻滞和囊周神经群阻滞）对术后疼痛的影响。测量患者在麻醉后恢复室期间静脉注射吗啡的消耗量，并在术后 24 小时和 48 小时评估阿片类药物解救的次数。作为次要目标，根据其他感兴趣的变量确定神经损伤、股四头肌阻滞延长和吗啡消耗的发生率。
本观察性回顾性研究收集了 2018 年 4 月至 2020 年 8 月间 656 例创伤外科手术患者的电子病历数据，纳入标准为：年龄大于 18 岁，ASA I-III 级，全身麻醉或蛛网膜下腔麻醉下进行初次全髋关节置换术（仅使用布比卡因重比重液），并使用左旋布比卡因进行外周神经阻滞。
共选择了 362 名患者。主要手术适应证为髋关节骨关节炎（61.3%），其次为髋部骨折（22.6%）。169 名患者（66.3%股神经，27.7% PENG，6.0%髂筋膜）接受了外周神经阻滞。在接受 PENG（2.2mg）或股神经阻滞（3.27mg）的患者中，PACU 术后阿片类药物的平均消耗量低于未接受神经阻滞的患者（6.69mg）。在术后 24 小时和 48 小时，阿片类药物解救无差异。神经损伤的发生率较低（0.8%），与神经阻滞无关。股四头肌瘫痪延长的发生率也较低（1.3%），主要与股神经阻滞相关（75%的病例）。
这项回顾性研究支持将区域阻滞作为阿片类药物节约技术，突出了它们在快速功能恢复而无运动损伤方面的作用。
