Abdelfatah Fatma Ahmed, Elhadad Mona Ahmed
Department of Anesthesia and Surgical Intensive Care, Benha University, Benha, Egypt.
Br J Pain. 2024 Oct;18(5):425-432. doi: 10.1177/20494637241262516. Epub 2024 Jun 14.
The pericapsular nerve group (PENG) block offers effective postoperative pain relief following hip fracture surgery. This research investigated three doses of bupivacaine, all administered in the same total volume, for performing ultrasound-guided PENG blocks during hip fracture procedures.
This randomized, double-blinded clinical trial was conducted on 135 patients aged between 18 and 70 years of both sexes who underwent hip fracture surgeries. Participants were randomized into three groups ( = 45). Ultrasound-guided PENG block was applied, the groups received 20 mL of local anesthetics. The first group received 0.5% bupivacaine, the second group received 0.375% bupivacaine, and the third group received 0.25% bupivacaine. The following parameters were recorded: onset of sensory block, resting NRS after passively raising the limb by 15° half an hour post-procedure, quality of recovery score (QoR-15) at 24 h postoperative.
The 0.25% bupivacaine group exhibited a longer sensory block onset than the other groups ( ≤ .05). Significant differences were demonstrated between the groups regarding the time to 1st analgesia ( = .033) and total morphine consumption ( = .025). NRS at baseline and T30 post-block did not show significant differences between the studied groups. No significant differences were detected postoperatively in rest and dynamic NRS ( ≤ .05). Patient satisfaction, QoR-15 score, and ease of spinal positioning did not differ between the groups.
Compared to 0.25% bupivacaine, PENG block with 0.5% and 0.375% bupivacaine provided a rapid onset sensory block, delayed first analgesic requirements, and reduced total morphine consumption after hip surgeries.
The trial was registered at the clinicaltrials.gov with study number (Trial ID: NCT05788458).
关节囊周围神经组（PENG）阻滞可为髋部骨折手术后提供有效的术后疼痛缓解。本研究调查了在髋部骨折手术过程中用于实施超声引导下PENG阻滞的三种布比卡因剂量，所有剂量的总体积相同。
本随机、双盲临床试验纳入了135例年龄在18至70岁之间、接受髋部骨折手术的男女患者。参与者被随机分为三组（每组n = 45）。实施超声引导下的PENG阻滞，三组均接受20 mL局部麻醉剂。第一组接受0.5%布比卡因，第二组接受0.375%布比卡因，第三组接受0.25%布比卡因。记录以下参数：感觉阻滞起效时间、术后半小时被动抬高肢体15°时的静息数字疼痛评分（NRS）、术后24小时的恢复质量评分（QoR-15）。
0.25%布比卡因组的感觉阻滞起效时间比其他组更长（P≤0.05）。在首次镇痛时间（P = 0.033）和吗啡总消耗量（P = 0.025）方面，各组之间存在显著差异。研究组之间在基线和阻滞后30分钟时的NRS无显著差异。术后静息和动态NRS均未检测到显著差异（P≤0.05）。各组之间的患者满意度、QoR-15评分和脊柱定位的难易程度无差异。
与0.25%布比卡因相比，0.5%和0.375%布比卡因的PENG阻滞在髋部手术后可提供更快起效的感觉阻滞、延迟首次镇痛需求并减少吗啡总消耗量。
该试验已在clinicaltrials.gov上注册，研究编号（试验ID：NCT05788458）。
