髋关节半关节置换术中腹股沟上筋膜髂骨阻滞的时机：对QoR-15评分的影响——一项前瞻性随机研究。
Timing of suprainguinal fascia iliaca block in hip hemiarthroplasty: impact on QoR-15 scores- a prospective randomized study.
作者信息
Mendes Ergun, Adiyeke Ozal, Sarban Onur, Civan Melih, Ozcan Funda Gumus
机构信息
Department of Anesthesiology and Reanimation, Koç University Faculty of Medicine Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Istanbul Basaksehir Cam and Sakura City Health Application and Research Center, University of Health Sciences, Istanbul, Turkey.
出版信息
BMC Anesthesiol. 2025 Apr 12;25(1):179. doi: 10.1186/s12871-025-03060-8.
BACKGROUND
Suprainguinal Fascia Iliaca Compartment Block (SFICB) is a widely utilized technique for managing postoperative pain in hip surgery. The timing of its administration, either preoperative or postoperative, plays a crucial role in influencing patient outcomes. This study aims to compare the effects of preoperative versus postoperative SFICB on postoperative recovery in patients undergoing hip hemiarthroplasty (HHA).
METHODS
In this prospective randomized trial, 60 patients scheduled for HHA were randomly assigned to two groups: Group PreS (preoperative SFICB) and Group PostS (postoperative SFICB). SFICB was performed under ultrasound guidance using 0.20% bupivacaine. The primary outcome was assessed using the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the Nursing Delirium Screening Scale (N-DSS), postoperative nausea/vomiting (PONV), and opioid consumption.
RESULTS
Demographic variables were comparable between groups (p > 0.05). Spinal anesthesia duration was shorter in Group PreS (p = 0.005), while surgery and total procedure times were similar (p > 0.05). QoR-15 scores improved in both groups, with significant increases in moderate (p = 0.004, p = 0.047) and severe pain (p < 0.001, p = 0.028). At T1, total QoR-15 (p = 0.034) and severe pain score (p < 0.001) were significantly better in Group PreS. Preoperative fentanyl need was lower in Group PreS (p < 0.001). Although first rescue analgesia time was longer in Group PostS (p = 0.026) morphine equivalent consumption (p = 0.564) was similar. N-DSS, delirium incidence, and PONV showed no differences (p > 0.05). No complications were observed.
CONCLUSIONS
Preoperative SFICB improved postoperative QoR-15 scores compared to postoperative SFICB in elderly HHA patients, but optimal timing and perioperative settings require further research.
TRIAL REGISTRATION
ClinicalTrials.gov (ID NCT05965544). The clinical trial was prospectively registered on July 20, 2023.
背景
腹股沟上筋膜髂筋膜间隙阻滞（SFICB）是一种广泛应用于髋关节手术术后疼痛管理的技术。其给药时机，无论是术前还是术后，对患者预后都起着至关重要的作用。本研究旨在比较术前与术后SFICB对接受髋关节半关节置换术（HHA）患者术后恢复的影响。
方法
在这项前瞻性随机试验中，60例计划接受HHA的患者被随机分为两组：术前SFICB组（PreS组）和术后SFICB组（PostS组）。在超声引导下使用0.20%布比卡因进行SFICB。主要结局在术后24小时使用恢复质量-15（QoR-15）评分进行评估。次要结局包括护理谵妄筛查量表（N-DSS）、术后恶心/呕吐（PONV）和阿片类药物消耗量。
结果
两组间人口统计学变量具有可比性（p>0.05）。PreS组脊麻持续时间较短（p=0.005），而手术时间和总手术时间相似（p>0.05）。两组QoR-15评分均有所改善，中度疼痛（p=0.004，p=0.047）和重度疼痛（p<0.001，p=0.028）显著增加。在T1时，PreS组的总QoR-15评分（p=0.034）和重度疼痛评分（p<0.001）明显更好。PreS组术前芬太尼需求量较低（p<0.001）。虽然PostS组首次补救镇痛时间较长（p=0.026），但吗啡等效消耗量相似（p=0.564）。N-DSS、谵妄发生率和PONV无差异（p>0.05）。未观察到并发症。
结论
与术后SFICB相比,术前SFICB可改善老年HHA患者术后QoR-15评分，但最佳给药时机和围手术期设置仍需进一步研究。
试验注册
ClinicalTrials.gov（ID NCT05965544）。该临床试验于2023年7月20日进行前瞻性注册。
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