Department of Anesthesiology, Kameda Medical Center, Kamogawa, Japan.
Department of Anesthesiology and Resuscitology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
BMC Anesthesiol. 2024 Nov 27;24(1):436. doi: 10.1186/s12871-024-02620-8.
Despite surgery intervention for femoral neck fractures is recommended within 48 h of admission, achieving timely surgery presents challenges for patients with severe comorbidities, or in resource-limited settings. Preoperative rehabilitation (prehabilitation) reduces bedridden time, enhances mobility, and improves postoperative outcomes for patients scheduled for hip arthroplasty due to femoral neck fractures. However, prehabilitation is hindered by insufficient pain control. The pericapsular nerve group (PENG) block provides effective analgesia while preserving motor function. We designed a study to assess the efficacy of PENG block in facilitating prehabilitation for patients with femoral neck fractures who are scheduled for hip arthroplasty.
This prospective randomized placebo-controlled double-blinded trial aims to enroll 100 patients with Garden 3 or 4 femoral neck fractures who are scheduled for hip arthroplasty. Participants will be randomly assigned to receive a PENG block with 0.375% ropivacaine (PENG group) or with normal saline (placebo group) before the initial prehabilitation session. The prehabilitation program comprises five items: Bed-sitting, Edge-sitting, Stand-up, Maintaining-standing, and Wheelchair-transfer, performed with the assistance of a single physical therapist. The primary outcome is the percentage of patients completing the entire prehabilitation program. Secondary outcomes during the initial prehabilitation session are the achievement of each program item and the Numerical Rating Scale (NRS) pain score. Other secondary outcomes include intraoperative bleeding amounts, thromboembolic events during postoperative day 0 to 7, postoperative 3-day cumulative Cumulated Ambulation Score (CAS), and discharge destination. The postoperative outcomes will be compared between subgroups of patients undergoing surgery within 48 h of admission and those undergoing surgery more than 48 h of admission.
This is the first study aiming to assess the efficacy of PENG block in prehabilitation for patients with femoral neck fractures who are scheduled for hip arthroplasty. PENG block could be beneficial, especially for patients facing delayed surgery, providing a potential treatment option during the waiting period.
Japan Registry of Clinical Trials, jRCT1031220294, registered on August 26, 2022.
尽管建议股骨颈骨折患者在入院后 48 小时内进行手术干预，但对于患有严重合并症的患者或在资源有限的环境中，实现及时手术具有挑战性。术前康复（prehabilitation）可减少卧床时间，提高活动能力，并改善因股骨颈骨折接受髋关节置换术的患者的术后结果。然而，prehabilitation 受到疼痛控制不足的阻碍。囊周神经群（PENG）阻滞可提供有效的镇痛效果，同时保留运动功能。我们设计了一项研究，以评估 PENG 阻滞在促进计划接受髋关节置换术的股骨颈骨折患者 prehabilitation 中的疗效。
本前瞻性随机安慰剂对照双盲试验旨在纳入 100 名 Garden 3 或 4 型股骨颈骨折且计划接受髋关节置换术的患者。参与者将被随机分配接受 0.375%罗哌卡因的 PENG 阻滞（PENG 组）或生理盐水（安慰剂组），然后再进行首次 prehabilitation 治疗。prehabilitation 方案包括五项内容：床上坐起、床边坐起、站立、保持站立和轮椅转移，由一名物理治疗师协助完成。主要结局是完成整个 prehabilitation 方案的患者比例。首次 prehabilitation 治疗时的次要结局是每个方案项目的完成情况和数字评分量表（NRS）疼痛评分。其他次要结局包括术中出血量、术后 0 至 7 天内的血栓栓塞事件、术后 3 天累积的活动评分（CAS）和出院去向。将对入院后 48 小时内和入院后超过 48 小时进行手术的患者亚组进行术后结局比较。
这是第一项旨在评估 PENG 阻滞在计划接受髋关节置换术的股骨颈骨折患者 prehabilitation 中的疗效的研究。PENG 阻滞可能有益，特别是对于面临延迟手术的患者，为等待期间提供了一种潜在的治疗选择。
日本临床试验注册中心，jRCT1031220294，于 2022 年 8 月 26 日注册。
