Gargano Francesca, Migliorelli Sabrina, Pascarella Giuseppe, Costa Fabio, Strumia Alessandro, Bellezze Alice, Ruggiero Alessandro, Carassiti Massimiliano
Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy.
Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy -
Minerva Anestesiol. 2025 Jun;91(6):524-532. doi: 10.23736/S0375-9393.24.18534-3. Epub 2024 Dec 10.
Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB).
Forty patients were randomly allocated to receive a PENG block or FNB and ONB, both combined with wound infiltration (WI). The main outcome was pain, assessed using a Numeric Rating Scale (NRS) 30 minutes after the block, in Post Anesthesia Care Unit (PACU) and in the postoperative six, 12 and 24 hours. Secondary outcomes included intra and postoperative analgesic requirement, need to increase the level of sedation and postoperative complications.
We observed, except for 12 hours post-surgery, higher NRS values for PENG group compared to FNB + ONB group, with a median (IQR) NRS of 3 (2-4) vs. 2 (1-3.25) 30 minutes after the block, 1.5 (0-3.25) vs. 0 (0-1.25) at PACU, 1.5 (0-2) vs. 1 (0-2.25) at six hours, 1.5 (0-2) vs. 2 (1-2) at 12 hours, and 2 (0-2) vs. 1.5 (0-2) at 24 hours. Despite this, no result was statistically significant; all P>0.05. No differences were observed as regards other secondary outcomes.
Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.
局部区域麻醉常用于骨科创伤手术，尤其是老年患者。我们进行了一项前瞻性、单中心、随机对照试验，以评估在接受抗血栓药物治疗的髋部骨折手术患者中，关节囊周围神经组（PENG）阻滞的麻醉和镇痛效果，并将其与股神经和闭孔神经阻滞（FNB+ONB）进行比较。
40例患者被随机分配接受PENG阻滞或FNB与ONB联合阻滞，两者均联合伤口浸润（WI）。主要结局指标为疼痛，在阻滞30分钟后、麻醉后恢复室（PACU）以及术后6、12和24小时使用数字评分量表（NRS）进行评估。次要结局指标包括术中及术后镇痛需求、增加镇静水平的必要性以及术后并发症。
我们观察到，除了术后12小时外，PENG组的NRS值高于FNB+ONB组，阻滞30分钟后的NRS中位数（IQR）为3（2-4） 比 2（1-3.25），在PACU时为1.5（0-3.25） 比 0（0-1.25），6小时时为1.5（0-2） 比 1（0-2.25），12小时时为1.5（0-2） 比 2（1-2），24小时时为2（0-2） 比 1.5（0-2）。尽管如此，没有结果具有统计学意义；所有P>0.05。在其他次要结局指标方面未观察到差异。
我们的结果表明，在接受抗血栓药物治疗的髋部骨折手术患者中，PENG阻滞作为一种麻醉和镇痛技术并不劣于FNB+ONB。
