Johnson Ellen L H, Kelly Tara L, Wolf Bethany J, Hansen Erik, Brown Andrew, Lautenschlager Carla, Wilson Sylvia H
medRxiv. 2024 Jul 18:2024.07.18.24310628. doi: 10.1101/2024.07.18.24310628.
INTRODUCTION: The quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block both provide effective postoperative analgesia after hip surgery while minimizing impact on motor function. This study aimed to compare QLB and PENG in patients undergoing primary total hip arthroplasty. METHODS: This superiority trial randomized patients scheduled for elective total hip arthroplasty to receive a lateral QLB or PENG with lateral femoral cutaneous nerve blocks for postoperative analgesia. Perioperative analgesic protocols were standardized. The primary outcome was postoperative cumulative opioid consumption at 72 hours. Secondary outcome was postoperative pain scores. Additional outcomes of interest included time to first ambulation, length of stay, patient reported outcome measures, and opioid-related side effects. RESULTS: This trial consented and randomized 106 subjects and 101 were included in analysis: PENG (n=50), QLB (n=51). Mean (95% CI) opioid consumption (IV MME) in the first 72 hours did not differ between PENG [109.6 (93.6, 125.6)] and QL [92.3 (76.6, 107.9)] groups (p=0.129) There were no significant differences between treatment arms in average pain score, time to ambulation, distance ambulated, rate of same day discharge, or hospital length of stay. There were also no differences in patient reported outcomes using HOOS-JR and PROMIS-10 scores. CONCLUSION: Patients undergoing primary THA receiving preoperative PENG vs QLB had similar opioid consumption, pain scores, time to ambulation, and hospital length of stay. Both QL and PENG blocks are analgesic options in patients undergoing primary THA. CLINICAL TRIALS REGISTRATION: NCT05710107; www.ClinicalTrial.gov IRB Protocol ID: Pro00124880. KEY MESSAGE: Pericapsular nerve group (PENG) block may provide analgesia after hip arthroplasty and improve early functional recovery. This study evaluated postoperative opioid consumption in patients randomized to PENG or lateral quadratus lumborum block (QLB).Opioid consumption, pain scores, motor recovery, and functional outcome measures did not differ in patients randomized to PENG vs lateral QLB.PENG and lateral QLBs are analgesic options following total hip arthroplasty with similar rates of same day discharge.
引言：腰方肌阻滞（QLB）和关节囊周围神经组（PENG）阻滞在髋关节手术后均能提供有效的术后镇痛，同时对运动功能的影响最小。本研究旨在比较初次全髋关节置换术患者中QLB和PENG的效果。 方法：这项优效性试验将计划进行择期全髋关节置换术的患者随机分为接受外侧QLB或PENG联合股外侧皮神经阻滞以进行术后镇痛。围手术期镇痛方案标准化。主要结局是术后72小时的累积阿片类药物消耗量。次要结局是术后疼痛评分。其他感兴趣的结局包括首次下床活动时间、住院时间、患者报告的结局指标以及与阿片类药物相关的副作用。 结果：本试验纳入并随机分组了106名受试者，101名纳入分析：PENG组（n = 50），QLB组（n = 51）。PENG组[109.6（93.6，125.6）]和QLB组[92.3（76.6，107.9）]在前72小时的平均（95%CI）阿片类药物消耗量（静脉注射吗啡毫克当量）无差异（p = 0.129）。治疗组之间在平均疼痛评分、下床活动时间、行走距离、当日出院率或住院时间方面无显著差异。使用HOOS-JR和PROMIS-10评分的患者报告结局也无差异。 结论：接受术前PENG或QLB的初次全髋关节置换术患者在阿片类药物消耗量、疼痛评分、下床活动时间和住院时间方面相似。QLB和PENG阻滞都是初次全髋关节置换术患者的镇痛选择。 临床试验注册：NCT05710107；www.ClinicalTrial.gov机构审查委员会方案编号：Pro00124880。 关键信息：关节囊周围神经组（PENG）阻滞可能在髋关节置换术后提供镇痛并改善早期功能恢复。本研究评估了随机分组接受PENG或外侧腰方肌阻滞（QLB）的患者术后阿片类药物消耗量。随机分组接受PENG与外侧QLB的患者在阿片类药物消耗量、疼痛评分、运动恢复和功能结局指标方面无差异。PENG和外侧QLB是全髋关节置换术后的镇痛选择，当日出院率相似。
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