Elhamrawy Amr, Kerbage Josiane, Veneziano Giorgio, Martin David P, Tobias Joseph D
Department of Anesthesiology, Detroit Medical Center/ Wayne State University School of Medicine, Detroit, MI, USA.
Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.
J Pain Res. 2024 Nov 9;17:3697-3705. doi: 10.2147/JPR.S481273. eCollection 2024.
Hip disorders in infants and children may result from congenital, infectious, developmental, inflammatory, neoplastic, and traumatic etiologies. Postoperative pain management associated with hip pathologies can be challenging especially due to complex innervation of the hip and surrounding structures. Given the adverse effect profile of systemic opioids, regional anesthesia offers an excellent alternative with more beneficial adverse effect profile. Various peripheral regional anesthetic techniques have been reported with variable results regarding analgesia and differing adverse effect profiles. The pericapsular nerve group (PENG) block is a novel motor-sparing regional anesthetic technique where the local anesthetic agent is deposited in the musculofascial plane between the psoas tendon and the pubic ramus. The main target is the genicular branches of the femoral, obturator, and accessory obturator nerve, which innervate the hip capsule. The anatomy involved with PENG block is reviewed and previous reports of PENG block in pediatric-aged patients, including single shot or continuous catheter techniques, are reviewed.
婴幼儿髋关节疾病可能由先天性、感染性、发育性、炎症性、肿瘤性和创伤性病因引起。与髋关节病变相关的术后疼痛管理可能具有挑战性，尤其是由于髋关节及其周围结构的神经支配复杂。鉴于全身用阿片类药物的不良反应，区域麻醉提供了一种不良反应较小的极佳替代方案。已报道了各种外周区域麻醉技术，其镇痛效果和不良反应各不相同。关节周围神经组（PENG）阻滞是一种新型的保留运动功能的区域麻醉技术，局部麻醉剂注射于腰大肌腱和耻骨支之间的肌筋膜平面。主要靶点是股神经、闭孔神经和闭孔副神经的膝状支，它们支配髋关节囊。本文回顾了与PENG阻滞相关的解剖结构，并回顾了先前关于小儿患者PENG阻滞的报道，包括单次注射或连续导管技术。
