Huang Ying, Peng Sheng, Wang Jun, Liu Lang, Dong Chun-Shan
Department of Anesthesiology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
Department of Anesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People's Hospital), Hefei, Anhui, People's Republic of China.
J Pain Res. 2025 May 24;18:2679-2688. doi: 10.2147/JPR.S517578. eCollection 2025.
Pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca block (S-FICB) provides incomplete analgesia for total hip arthroplasty (THA) due to anatomical limitations. This study compares two modified approaches-PENG block with wound infiltration (WI) and a modified S-FICB-to identify the optimal analgesic technique for THA.
Eighty-six subjects were randomly allocated to either the PENG block + WI group or the modified S-FICB group. The primary outcome was the postoperative numeric rating scale (NRS) pain scores (rest/hip adduction) at 6 hours. The secondary outcomes were pain scores at 12, 24, 48 hours postoperatively and postoperative day 5, the incidence of postoperative quadriceps motor block at 6, 12, 24, 48 hours and postoperative day 5, the mean blood pressure (MAP) at five time points, patient-controlled intravenous analgesia (PCIA) usage and adverse effects such as the incidence of rescue analgesia, local anesthetic systemic toxicity (LAST), postoperative hip infection, the incidence of postoperative nausea and vomiting (PONV) within 5 days after surgery.
PENG + WI group had lower NRS at rest (6h) (95% CI 0.51-1.64, p<0.001). Compared with the PENG block + WI, the modified S-FICB resulted in a higher incidence of quadriceps motor block at 6 hours (82.1% vs 25.6%; OR=13.257, 95% CI 4.46-39.38; p<0.001) and 12 hours (71.8% vs 41%; OR=3.659, 95% CI 1.42-9.42; p=0.001).
PENG block + WI provides sufficient postoperative analgesia with no quadriceps motor block compared to modified S-FICB, supporting early ambulation and in line with the enhanced recovery after surgery (ERAS) protocols.
由于解剖学限制，关节囊周围神经组（PENG）阻滞和腹股沟上髂筋膜阻滞（S-FICB）为全髋关节置换术（THA）提供的镇痛并不完全。本研究比较了两种改良方法——PENG阻滞联合伤口浸润（WI）和改良S-FICB——以确定THA的最佳镇痛技术。
86名受试者被随机分配至PENG阻滞+WI组或改良S-FICB组。主要结局指标为术后6小时的数字评分量表（NRS）疼痛评分（静息/髋关节内收）。次要结局指标为术后12、24、48小时及术后第5天的疼痛评分，术后6、12、24、48小时及术后第5天股四头肌运动阻滞的发生率，五个时间点的平均血压（MAP），患者自控静脉镇痛（PCIA）的使用情况以及不良反应，如补救镇痛的发生率、局部麻醉药全身毒性（LAST）、术后髋关节感染、术后5天内术后恶心呕吐（PONV）的发生率。
PENG+WI组静息时（6小时）的NRS较低（95%可信区间0.51-1.64，p<0.001）。与PENG阻滞+WI相比，改良S-FICB在6小时（82.1%对25.6%；OR=13.257，95%可信区间4.46-39.38；p<0.001）和12小时（71.8%对41%；OR=3.659，95%可信区间1.42-9.42；p=0.001）时导致股四头肌运动阻滞的发生率更高。
与改良S-FICB相比,PENG阻滞+WI提供了充分的术后镇痛，且无股四头肌运动阻滞，支持早期活动，符合术后加速康复（ERAS）方案。
