Duan Lei, Li Jianzhong, Chen Zhe, Wen Tao, He Junyang, Zhang Afeng
Department of Anesthesiology, Xi'an Aerospace General Hospital, Xi'an City, China.
Department of Anesthesiology, Norinco General Hospital, Xi'an City, 710065, China.
BMC Anesthesiol. 2024 Oct 1;24(1):352. doi: 10.1186/s12871-024-02731-2.
Pain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function.
This case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded.
They experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients.
Ultrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.
股骨颈骨折（FNF）全髋关节置换术（THA）后的疼痛可能很严重，有可能导致严重并发症。腰丛神经阻滞已成为髋部骨折手术中一种可选的局部镇痛策略，但它无法为髋关节后关节囊提供有效的疼痛缓解。因此，我们对传统的骶丛神经阻滞进行了改良，并将其命名为髋关节后关节囊阻滞（PHPB），以补充对支配髋关节后关节囊区域相关神经的阻滞。由此，我们详细阐述了PHPB联合腰丛神经阻滞对5例髋部骨折患者的镇痛效果及其对髋关节运动功能的影响。
本病例系列研究于2023年12月至2024年2月进行。我们对5例髋部骨折患者实施了超声引导下的PHPB联合腰丛神经阻滞。记录了这5例患者术后48小时内静息时的数字评定量表（NRS）疼痛评分以及肢体运动时的最大NRS疼痛评分。还记录了他们的髋关节屈曲、外展、内收、膝关节屈曲以及股四头肌力量。记录了术后严重并发症，包括伤口感染、血肿形成或神经损伤。
他们在术后48小时内实现了有效的疼痛控制，静息时的NRS疼痛评分从3.0（3.0，4.5）降至0.0（0.0，1.0），肢体运动时的最大NRS疼痛评分从8.0（7.5，8.5）降至1.0（0.5，2.0）。他们在术后48小时内能够自主进行髋关节屈曲、外展、内收和膝关节屈曲，没有任何运动障碍或股四头肌无力的迹象。所有患者均未观察到严重的术后并发症，如伤口感染、血肿形成或神经损伤。
超声引导下的腰丛神经阻滞联合PHPB为髋部骨折患者围手术期提供了有效的镇痛。它在全髋关节置换术后24小时内维持了髋关节运动功能和股四头肌力量。
