VanEenenaam David P, Cardin Stefano, Yang Daniel, O'Brien Elizabeth, Muhly Wallis T, Sankar Wudbhav N
From the Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (VanEenenaam, Cardin, Yang, and Sankar), and the Division of General Anesthesiology (O'Brien and Muhly), Children's Hospital of Philadelphia, Philadelphia, PA.
J Am Acad Orthop Surg. 2024 Dec 15;32(24):1123-1129. doi: 10.5435/JAAOS-D-24-00177. Epub 2024 May 14.
Adequate pain control and early mobilization are critical in the postoperative period after periacetabular osteotomy (PAO). Regional anesthesia can reduce postoperative pain, but certain techniques can increase the risk of postoperative motor block and delayed functional recovery. Continuous lumbar epidurals can provide excellent analgesia but also create challenges with early ambulation. Recently, suprainguinal fascia iliaca (SIFI) single-shot blocks have been shown to provide effective analgesia in PAO patients. The goal of this study was to compare opioid use, time to achieve inpatient physical therapy (PT) goals, and length of stay (LOS) between a cohort of patients receiving SIFI blocks and a cohort of patients receiving epidural analgesia (EA).
This retrospective single-surgeon comparative cohort study included all patients who underwent a PAO between 2012 and 2022. Regional anesthetic technique (SIFI vs EA), length of hospital stay, intraoperative and postoperative opioid use, pain scores, and time to achievement of PT milestones before discharge were recorded. Patients were excluded if they had any preexisting neuromuscular syndrome or neurosensory deficit. All opioid use was converted to morphine-milligram equivalents using standard conversions.
Two hundred four surgeries were done over the study period; 164 patients received EA, and 40 received a SIFI block. The average age of our cohort was 19.5 years (±6 yrs). The SIFI cohort had a significantly shorter mean LOS than the EA cohort (2.9 vs 4.1 days, P < 0.001). Patients in the SIFI cohort achieved all PT ambulation goals significantly sooner than the lumbar epidural group ( P < 0.001), with lower total opioid use on each postoperative day. No notable differences were observed in sex, race, BMI, or pain scores at inpatient PT visits before discharge.
After PAO surgery, the SIFI block is associated with shorter hospital LOS, reduced postoperative opioid use, and earlier mobilization when compared with those who were managed with an epidural.
在髋臼周围截骨术（PAO）后的术后阶段，充分的疼痛控制和早期活动至关重要。区域麻醉可减轻术后疼痛，但某些技术会增加术后运动阻滞和功能恢复延迟的风险。持续腰段硬膜外麻醉可提供出色的镇痛效果，但也给早期下床活动带来挑战。最近，腹股沟上髂筋膜（SIFI）单次阻滞已被证明可为PAO患者提供有效的镇痛作用。本研究的目的是比较接受SIFI阻滞的患者队列与接受硬膜外镇痛（EA）的患者队列之间的阿片类药物使用情况、达到住院物理治疗（PT）目标的时间以及住院时间（LOS）。
这项回顾性单外科医生比较队列研究纳入了2012年至2022年间所有接受PAO手术的患者。记录区域麻醉技术（SIFI与EA）、住院时间、术中和术后阿片类药物使用情况、疼痛评分以及出院前达到PT里程碑的时间。如果患者有任何既往神经肌肉综合征或神经感觉缺陷，则将其排除。所有阿片类药物的使用均使用标准换算方法换算为吗啡毫克当量。
在研究期间共进行了204例手术；164例患者接受了EA，40例接受了SIFI阻滞。我们队列的平均年龄为19.5岁（±6岁）。SIFI队列的平均住院时间明显短于EA队列（2.9天对4.1天，P<0.001）。SIFI队列的患者比腰段硬膜外组显著更快地实现了所有PT下床活动目标（P<0.001），且术后每天的阿片类药物总使用量更低。出院前住院PT就诊时，在性别、种族、BMI或疼痛评分方面未观察到显著差异。
与接受硬膜外麻醉管理的患者相比，PAO手术后，SIFI阻滞与更短的住院时间、减少的术后阿片类药物使用以及更早的活动相关。
