Kroes Thamar, Wijnen Hugo H, Bos Koen, Wasmoeth Lennart G, van de Vossenberg Glenn, Spaetgens Bart, Smits Rachel J H, Schuijt Henk Jan, Willems Hanna C
Department of Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543, AZ, Utrecht, the Netherlands; Geriatrics Section, Department of Internal Medicine, Amsterdam University Medical Center location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
Department of Geriatrics, Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands.
J Clin Anesth. 2025 Jul;105:111872. doi: 10.1016/j.jclinane.2025.111872. Epub 2025 May 27.
Effective analgesia is critical yet challenging in non-operative management (NOM) of hip fractures for frail older patients in the palliative setting. Chemical hip denervation with phenol via PEricapsular Nerve Group (PENG) block has been applied to improve pain management. This is the first multicenter retrospective study that evaluated pain experience, opioid consumption and mobility in this population. The study included 185 patients, aged 70 years or older, who received chemical hip denervation with phenol via PENG block in the context of NOM from January 2022 until August 2023 in six hospitals across the Netherlands. Patient data were extracted from electronic health records. Patients were aged median 87 years (p25 - p75 82-91) with multiple comorbidities, the majority suffered from cognitive impairment (74 %) and depended on daily care (88 %). Phenol was mostly used with a concentration of 6 % (70 % of patients) or 10 % (23 % of patients) and a median volume of 10 ml (p25 - p75 8-10). Post procedural pain was experienced as acceptable in the majority of patients (89 % rest-related, 65 % care-related). The secondary outcomes of pain on a numeric rating scale (NRS) and morphine milligram equivalents (MME) were low. However, mobility remained limited. Median survival was 9 days (p25 - p75 4-22). Significant differences were observed in fracture type and hospital location. No complications or adverse treatment effects were reported. Chemical hip denervation with phenol via PENG block may be a viable analgesic option in selected frail older hip fracture patients as part of person-centered, multidisciplinary palliative care. Study limitations included its retrospective design with unavailable data on quality of life. Future prospective studies should evaluate patient outcomes. Further research is necessary to define optimal techniques, phenol percentage and volumes and reduce practice variability.
对于姑息治疗环境中体弱的老年患者，有效的镇痛在髋部骨折的非手术治疗（NOM）中至关重要但具有挑战性。通过经囊周神经组（PENG）阻滞用苯酚进行化学性髋关节去神经支配已被应用于改善疼痛管理。这是第一项评估该人群疼痛体验、阿片类药物消耗和活动能力的多中心回顾性研究。该研究纳入了185名年龄在70岁及以上的患者，他们于2022年1月至2023年8月在荷兰的六家医院接受了在NOM背景下通过PENG阻滞用苯酚进行的化学性髋关节去神经支配。患者数据从电子健康记录中提取。患者的年龄中位数为87岁（第25百分位数 - 第75百分位数为82 - 91岁），有多种合并症，大多数患有认知障碍（74%）且依赖日常护理（88%）。苯酚大多以6%的浓度（70%的患者）或10%的浓度（23%的患者）使用，中位体积为10毫升（第25百分位数 - 第75百分位数为8 - 10毫升）。大多数患者术后疼痛可接受（89%与休息相关，65%与护理相关）。数字评分量表（NRS）上的疼痛和吗啡毫克当量（MME）等次要结局较低。然而，活动能力仍然受限。中位生存期为9天（第25百分位数 - 第75百分位数为4 - 22天）。在骨折类型和医院位置方面观察到显著差异。未报告并发症或不良治疗效果。作为以患者为中心的多学科姑息治疗的一部分，通过PENG阻滞用苯酚进行化学性髋关节去神经支配可能是选定的体弱老年髋部骨折患者可行的镇痛选择。研究局限性包括其回顾性设计以及缺乏生活质量数据。未来的前瞻性研究应评估患者结局。有必要进一步研究以确定最佳技术、苯酚百分比和体积，并减少实践差异。
