Lee Tae Sung, Kwon Hyuck Min, Park Jun Young, Park Min Cheol, Choi Yong Seon, Park Kwan Kyu
Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea,
Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Gerontology. 2024;70(6):603-610. doi: 10.1159/000538614. Epub 2024 Apr 4.
The purpose of this study was to evaluate peripheral nerve block (PNB) effectiveness in postoperative pain management and surgical outcomes for displaced femoral-neck fracture in geriatric patients (>70 years) who underwent bipolar hemiarthroplasty (BHA).
From January 2017 to December 2021, 231 geriatric patients with displaced femoral-neck fracture who consecutively underwent BHA were retrospectively reviewed. Patients were divided into two groups: the patient-controlled analgesia (PCA) group (n = 132) who received only intravenous (IV) PCA for postoperative pain management, and all others who received PNB with IV PCA (PNB+PCA) such as femoral nerve block or fascia iliaca compartment block after surgery (n = 99). Primary outcomes were postoperative visual analog scale (VAS) at rest and during activity at 6, 24, and 48 h postoperatively. Secondary outcomes were postoperative complications, changes in hemoglobin, length of hospital stay, and total morphine usage after surgery.
Postoperative resting VAS at 6 h and 48 h was significantly lower in the PNB+PCA group compared with the PCA group (p = 0.075, p = 0.0318, respectively). However, there was no significant difference in either resting VAS at 24 h or active VAS. Complications of pneumonia and delirium until 1 month postoperative were significantly lower in the PNB + PCA group than the PCA group (p = 0.0022, p = 0.0055, respectively).
PNB with IV PCA seems to have a beneficial effect on geriatric femoral-neck patients who underwent BHA with postoperative analgesia for reducing postoperative resting pain and complications, especially pneumonia and delirium.
本研究的目的是评估老年患者（>70岁）行双极半髋关节置换术（BHA）时，外周神经阻滞（PNB）在术后疼痛管理及手术结局方面的有效性。
回顾性分析2017年1月至2021年12月期间连续接受BHA的231例老年股骨颈移位骨折患者。患者分为两组：仅接受静脉自控镇痛（PCA）进行术后疼痛管理的患者自控镇痛（PCA）组（n = 132），以及术后接受股神经阻滞或髂筋膜间隙阻滞等PNB联合静脉PCA（PNB + PCA）的其他所有患者（n = 99）。主要结局指标为术后6、24和48小时静息及活动时的视觉模拟评分（VAS）。次要结局指标为术后并发症、血红蛋白变化、住院时间及术后总吗啡用量。
与PCA组相比，PNB + PCA组术后6小时和48小时的静息VAS显著更低（分别为p = 0.075，p = 0.0318）。然而，24小时静息VAS或活动VAS均无显著差异。术后1个月内，PNB + PCA组的肺炎和谵妄并发症显著低于PCA组（分别为p = 0.0022，p = 0.0055）。
PNB联合静脉PCA似乎对接受BHA的老年股骨颈患者术后镇痛有益，可减轻术后静息疼痛及并发症，尤其是肺炎和谵妄。
