Aslan Mustafa, Kilicaslan Alper, Gök Funda, Kekec Ahmet Fevzi, Colak Tahsin Sami
Turhal State Hospital, Department of Anaesthesiology and Reanimation, Tokat, Turkey.
Necmettin Erbakan University, Meram Medical Faculty, Department of Anaesthesiology and Reanimation, Konya, Turkey.
Braz J Anesthesiol. 2025 May 23;75(5):844643. doi: 10.1016/j.bjane.2025.844643.
This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).
In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.
No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.
Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.
本研究比较了全髋关节置换术（THA）患者中，关节周围神经丛（PENG）阻滞联合股外侧皮神经（LFCN）阻滞与腰方肌前阻滞（QLB）的效果。
在这项前瞻性双盲试验中，80例计划在脊髓麻醉下进行THA的成年人被随机分为两组，一组接受30毫升0.25%布比卡因的QLB（n = 40），另一组接受联合PENG + LFCN阻滞（n = 40），其中PENG使用25毫升0.25%布比卡因，LFCN使用5毫升。主要结局是术后24小时静脉注射吗啡的累积用量。次要结局包括疼痛评分、股四头肌力量、患者满意度和副作用。
两组在术后前12小时的吗啡用量或疼痛评分方面无显著差异（p > 0.05）。在24小时时，PENG + LFCN组的吗啡用量显著更低（p = 0.027），静息视觉模拟评分（VAS）也更低（p < 0.001）。6小时时，15%（6/40）的QLB患者出现股四头肌无力（p = 0.026），而PENG + LFCN组在24小时内未观察到无力情况。两组患者的满意度和并发症发生率相当。
QLB和PENG + LFCN阻滞在THA术后12小时内均提供有效的镇痛效果。然而，PENG + LFCN联合阻滞提供了更长时间的镇痛，减少了阿片类药物的需求，并更好地保留了股四头肌力量。
