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髋关节手术后关节囊周围神经组(PENG)阻滞的功能恢复和疼痛控制:一项随机对照试验的系统评价和荟萃分析

Functional recovery and pain control following Pericapsular Nerve Group (PENG) block following hip surgeries: a systematic review and meta-analysis of randomised controlled trials.

作者信息

Reysner Tomasz, Kowalski Grzegorz, Reysner Małgorzata, Mularski Aleksander, Daroszewski Przemysław, Wieczorowska-Tobis Katarzyna

机构信息

Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland.

Department of Forensic Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland.

出版信息

Arch Orthop Trauma Surg. 2025 Mar 19;145(1):198. doi: 10.1007/s00402-025-05825-9.

Abstract

PURPOSE

The Pericapsular Nerve Group (PENG) block is a regional anaesthesia technique used in hip surgery. However, its effectiveness and analgesic efficiency, especially when compared to other regional anaesthesia techniques, have yet to be fully established. This meta-analysis aimed to determine the functional recovery and pain management following PENG block in Hip surgeries.

METHODS

Following PRISMA guidelines, we conducted a meta-analysis of prospective randomised clinical trials that compared the effects of PENG block versus the control group or different regional anaesthesia techniques in hip surgeries. The study was registered on the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42024529125).

RESULTS

Nineteen studies encompassing 1682 participants were included for the synthesis after critical evaluation. Ultrasound-guided PENG block improved functional recovery when compared to no block anaesthesia (RR 0.48, 95% Cl 0.24, 0.96, p = 0.04) and different regional anaesthesia techniques (RR 0.45, 95% Cl 0.26, 0.77, p = 0.004). The PENG block showed a reduction of postoperative opioid consumption 24 h after surgery when compared to no block anaesthesia (SMD - 0.92, 95% Cl - 1.65, - 0.19; p = 0.01) and when compared to Fascia Iliaca Compartment Block (FICB) (SMD - 0.96, 95% Cl - 1.52, - 0.39, p = 0.0009).

CONCLUSION

The PENG block improved functional recovery Compared to no-block analgesia and different regional anaesthesia techniques. Also, the PENG block improved analgesic efficacy in hip surgeries compared to no-block anaesthesia and to FICB. However, due to the high heterogeneity of included studies, more high-quality, methodological, and strictly defined RCTs are urgently needed to evaluate the advantages and disadvantages of PENG block for Hip surgeries.

摘要

目的

关节囊周围神经组(PENG)阻滞是一种用于髋关节手术的区域麻醉技术。然而,其有效性和镇痛效果,尤其是与其他区域麻醉技术相比,尚未完全确立。本荟萃分析旨在确定髋关节手术中PENG阻滞后的功能恢复和疼痛管理情况。

方法

按照PRISMA指南,我们对前瞻性随机临床试验进行了荟萃分析,这些试验比较了PENG阻滞与对照组或不同区域麻醉技术在髋关节手术中的效果。该研究已在国际系统评价注册库(PROSPERO)注册,可在线获取(www.crd.york.uk/prospero,CRD42024529125)。

结果

经过严格评估,纳入了19项研究,共1682名参与者进行综合分析。与无阻滞麻醉(RR 0.48,95%CI 0.24,0.96,p = 0.04)和不同区域麻醉技术(RR 0.45,95%CI 0.26,0.77,p = 0.004)相比,超声引导下的PENG阻滞改善了功能恢复。与无阻滞麻醉相比(SMD -0.92,95%CI -1.65,-0.19;p = 0.01)以及与髂筋膜间隙阻滞(FICB)相比(SMD -0.96,95%CI -1.52,-0.39,p = 0.0009),PENG阻滞在术后24小时显示出阿片类药物消耗量减少。

结论

与无阻滞镇痛和不同区域麻醉技术相比,PENG阻滞改善了功能恢复。此外,与无阻滞麻醉和FICB相比,PENG阻滞在髋关节手术中提高了镇痛效果。然而,由于纳入研究的高度异质性,迫切需要更多高质量、方法学严谨且定义明确的随机对照试验来评估PENG阻滞在髋关节手术中的优缺点。

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