关节囊周围神经组与腰方肌外侧阻滞对初次全髋关节置换术后累积阿片类药物消耗量的影响比较：一项随机对照试验

Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial.

作者信息

Hay Ellen, Kelly Tara, Wolf Bethany J, Hansen Erik, Brown Andrew, Lautenschlager Carla, Wilson Sylvia H

机构信息

Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

出版信息

Reg Anesth Pain Med. 2024 Oct 10. doi: 10.1136/rapm-2024-105875.

DOI:10.1136/rapm-2024-105875

PMID:39389587

Abstract

INTRODUCTION

Both the quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block provide effective postoperative analgesia after hip surgery while minimizing the impact on motor function. This study aimed to compare QLB and PENG in patients undergoing primary total hip arthroplasty (THA).

METHODS

This superiority trial randomized patients scheduled for elective THA to receive a lateral QLB or a PENG with a lateral femoral cutaneous nerve (LFC) block for postoperative analgesia. Perioperative analgesic protocols were standardized. The primary outcome was postoperative cumulative opioid consumption measured over time up to 72 hours. Secondary outcomes included postoperative pain scores in the first 72 hours, time to ambulation, length of stay, and patient-reported functional outcome measures (Hip disability and Osteoarthritis Outcome Score for Joint Replacement and Patient-Reported Outcome Measures Information System-10 scores).

RESULTS

This trial consented and randomized 106 subjects and 101 were included in the analysis: PENG (n=50), QLB (n=51). Mean (95% CI) opioid consumption in intravenous morphine milligram equivalents differed at 36 hours (mean difference (95% CI), 18.0 (0.80, 35.1); p0.040), 48 hours (23.0 (5.20, 40.8); p=0.011), 60 hours (28.0 (9.24, 46.7); p=0.004), and 72 hours (33.0 (13.0, 53.0); p=0.001). There were no significant differences between treatment arms in average resting pain score, time to ambulation, rate of same-day discharge, length of stay, or patient-reported functional outcomes.

CONCLUSION

While both lateral QLB and PENG block+LFC block are effective analgesic methods for patients undergoing THA, patients receiving lateral QLB had decreased cumulative opioid consumption from 36 to 72 hours postoperative and lower pain scores with movement compared with patients receiving PENG+LFC blocks.

TRIAL REGISTRATION NUMBER

NCT05710107.

摘要

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，同时将对运动功能的影响降至最低。本研究旨在比较初次全髋关节置换术（THA）患者中QLB和PENG的效果。

方法

这项优效性试验将计划接受择期THA的患者随机分为两组，分别接受外侧QLB或PENG联合股外侧皮神经（LFC）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小时内随时间测量的累积阿片类药物消耗量。次要结局包括术后72小时内的疼痛评分、下床活动时间、住院时间以及患者报告的功能结局指标（髋关节功能障碍和关节置换骨关节炎结局评分以及患者报告结局测量信息系统-10评分）。

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）。静脉注射吗啡毫克当量的平均（95%CI）阿片类药物消耗量在36小时（平均差值（95%CI），18.0（0.80，35.1）；p = 0.040）、48小时（23.0（5.20，40.8）；p = 0.011）、60小时（28.0（9.24，46.7）；p = 0.004）和72小时（33.0（13.0，53.0）；p = 0.001）时存在差异。治疗组之间在平均静息疼痛评分、下床活动时间、当日出院率、住院时间或患者报告的功能结局方面无显著差异。