Department of Anaesthesiology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 104217, Taiwan.
Department of Anaesthesiology, Chang Gung Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333423, Taiwan; College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333001, Taiwan.
Injury. 2024 Dec;55(12):111936. doi: 10.1016/j.injury.2024.111936. Epub 2024 Oct 8.
Regional analgesia has been recommended to alleviate pain caused by hip fractures. Both the supra-inguinal fascia iliaca block (S-FIB) and the peri‑capsular nerve group (PENG) block provide better analgesia than conventional fascia iliaca block for patients with hip fractures, but which one is superior remains equivocal. This study aimed to determine the superiority of S-FIB or PENG block for patients awaiting hip surgery.
In this prospective, double-blind, randomised comparative trial, patients with hip fractures awaiting operation were randomly allocated to receive either S-FIB with 30 ml 0.35 % ropivacaine or PENG block with 20 ml 0.35 % ropivacaine. Primary outcomes were pain scores (numeric rating scale, NRS, 0-10) at rest and during passive movement 30 min after nerve block. Secondary outcomes included pain scores at rest and during movement 10 and 20 min after nerve block and during positioning for spinal anaesthesia, time spent for performing nerve block and spinal anaesthesia, and the quality of positioning for spinal anaesthesia.
One-hundred patients were enrolled and 91 patients completed the trial (S-FIB group n = 46, PENG group n = 45). No significant difference was noted between these two groups in the pain scores (median [interquartile range]) either at rest (0 [0-0] vs 0 [0-0], P = 0.151) or during passive movement (3 [1-6] vs 3 [2-5], P = 0.99) at 30 min after nerve block. However, within-group analysis revealed that a significant reduction in pain score at rest was noted as early as 20 min after PENG block while that was noted only at 30 min after S-FIB. In addition, less time was required to perform PENG than S-FIB the block (3.1 [2.3-3.9] vs. 4.6 [3.1-5.6] minutes, P < 0.001).
Our result suggests that with a lower dose of local anaesthetic, a shorter procedure time and earlier analgesic effect, PENG block may be preferred to S-FIB for patients with hip fracture awaiting surgery.
区域麻醉已被推荐用于缓解髋部骨折引起的疼痛。与传统的股神经筋膜阻滞（FIB）相比，骼筋膜间隙阻滞（PENG）和囊周神经群阻滞（PENG）都能为髋部骨折患者提供更好的镇痛效果，但哪种方法更优越仍存在争议。本研究旨在确定 S-FIB 与 PENG 阻滞在等待髋关节手术的患者中的优劣。
在这项前瞻性、双盲、随机对照试验中，接受髋关节手术的髋部骨折患者被随机分配接受 30ml0.35%罗哌卡因的 S-FIB 或 20ml0.35%罗哌卡因的 PENG 阻滞。主要结局是神经阻滞 30min 后静息和被动运动时的疼痛评分（数字评分量表，NRS，0-10）。次要结局包括神经阻滞后 10min 和 20min 静息和运动时的疼痛评分以及行脊髓麻醉时的体位、完成神经阻滞和脊髓麻醉的时间以及脊髓麻醉时的体位质量。
共纳入 100 例患者，91 例完成试验（S-FIB 组 n=46，PENG 组 n=45）。两组患者在神经阻滞后 30min 静息时（中位数[四分位间距]）（0[0-0] vs 0[0-0]，P=0.151）或被动运动时（3[1-6] vs 3[2-5]，P=0.99）的疼痛评分均无显著差异。然而，组内分析显示，PENG 阻滞后 20min 时静息疼痛评分显著降低，而 S-FIB 阻滞后 30min 时才降低。此外，PENG 阻滞的操作时间比 S-FIB 短（3.1[2.3-3.9] vs. 4.6[3.1-5.6]min，P<0.001）。
我们的结果表明，与 S-FIB 相比，PENG 阻滞用于髋部骨折患者时，局部麻醉药物剂量较低，操作时间较短，镇痛效果更早，可能是更好的选择。
