Ahmadzadeh Shahab, Walker Megan S, O'Dell Duplechin Mary, Duplechin Drake P, Fox Charles J, Shekoohi Sahar, Kaye Alan D
Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA 70112, USA.
J Clin Med. 2025 Jun 7;14(12):4050. doi: 10.3390/jcm14124050.
Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block have become the new point of focus as opposed to traditional methods previously used. This narrative review compares the SIFIB and the PENG block in their efficacy to treat post-operative pain management. Mechanism of action, safety, patient outcomes, and clinical applications are compared between the two blocks for evaluation. Clinical studies have indicated that both blocks reduce post-operative pain and reduce opioid use. In contrast, SIFIB has shown to be more preferred in more complex procedures such as total hip arthroplasty, which requires extensive nerve coverage despite its longer onset time. The SIFIB has been shown to carry a higher risk of impairing motor function, making the PENG highly preferred in patients where quick mobility improvement is prioritized. The PENG block also showed slightly higher efficacy in reducing pain associated with post-operative passive limb movements, and a slight decrease in opioid consumption in comparison to SIFIB in the early post-operative time frame. Although the PENG shows more benefits in the early stages of post-operative recovery, the SIFIB shows similar outcomes to PENG over longer durations of recovery. Future studies can aid in establishing a framework for tailoring block selection to individual patient needs to optimize clinical outcomes.
髋关节置换术后有效的疼痛管理对于改善患者恢复情况、减少阿片类药物使用、增强活动能力以及降低并发症风险至关重要。与先前使用的传统方法不同，包括腹股沟上髂筋膜阻滞（SIFIB）和关节周围神经组（PENG）阻滞在内的多模式麻醉策略已成为新的关注焦点。本叙述性综述比较了SIFIB和PENG阻滞在治疗术后疼痛管理方面的疗效。对两种阻滞的作用机制、安全性、患者预后及临床应用进行比较以作评估。临床研究表明，两种阻滞均能减轻术后疼痛并减少阿片类药物使用。相比之下，SIFIB在全髋关节置换等更复杂的手术中似乎更受青睐，这类手术需要广泛的神经覆盖，尽管其起效时间较长。已证明SIFIB存在更高的损害运动功能风险，这使得PENG在优先考虑快速改善活动能力的患者中更受青睐。与SIFIB相比，PENG阻滞在减少术后被动肢体运动相关疼痛方面也显示出略高的疗效，且在术后早期阿片类药物使用量略有减少。尽管PENG在术后恢复早期显示出更多益处，但在更长的恢复时间内，SIFIB与PENG的预后相似。未来的研究有助于建立一个根据个体患者需求定制阻滞选择的框架，以优化临床结果。
