Liu Xiaonan, Li Linlin, Liu Junfeng, Dong Yiming
Department of Anesthesiology, The Second People's Hospital of Dongying, Dongying, Shandong Province, People's Republic of China.
J Pain Res. 2025 Aug 1;18:3843-3850. doi: 10.2147/JPR.S517762. eCollection 2025.
Regional anesthetic techniques for hip fracture are critical for pain control, reducing perioperative adverse events, and minimizing postoperative opioid use. This case series investigates the use of a novel triple-block protocol-ultrasound-guided pericapsular nerve group (PENG) block, lateral femoral cutaneous nerve (LFCN) and sacral plexus blocks-in patients with hip fractures, focusing on its feasibility as an anesthetic strategy for high-risk hip fracture patients.
Five frail elderly patients with significant comorbidities and contraindications to neuraxial anesthesia underwent bipolar femoral head replacement surgery. Primary outcomes included anesthesia quality (0-3 scale: poor, acceptable, good, excellent) and postoperative analgesia. Secondary outcomes encompassed surgical conditions, complications, and patient satisfaction.
These combined blocks provided effective analgesia (Visual Analog Scale, [VAS] scores of 0-1 at PACU discharge) and preserved quadriceps motor function (Medical Research Council [MRC] scale 4-5). Surgical conditions were rated "excellent" in four cases and "acceptable" in one. Postoperative sufentanil consumption was low (36-83 μg via patient-controlled analgesia [PCA]). Complications included one case of surgical site dehiscence (requiring reoperation) and transient dizziness.
This triple-block technique offers comprehensive analgesia for high-risk hip fracture patients or those with contraindications to neuraxial anesthesia, enabling early mobilization and reducing opioid reliance. Larger randomized trials are warranted to confirm these findings.
髋部骨折的区域麻醉技术对于疼痛控制、减少围手术期不良事件以及尽量减少术后阿片类药物的使用至关重要。本病例系列研究了一种新型三联阻滞方案——超声引导下的关节周围神经组（PENG）阻滞、股外侧皮神经（LFCN）阻滞和骶丛阻滞——在髋部骨折患者中的应用，重点关注其作为高危髋部骨折患者麻醉策略的可行性。
五名体弱的老年患者，患有严重的合并症且有脊麻的禁忌症，接受了双极股骨头置换手术。主要结局包括麻醉质量（0 - 3级：差、可接受、好、优）和术后镇痛。次要结局包括手术条件、并发症和患者满意度。
这些联合阻滞提供了有效的镇痛（麻醉后监护病房（PACU）出院时视觉模拟评分（VAS）为0 - 1分），并保留了股四头肌运动功能（医学研究委员会（MRC）评分为4 - 5级）。四例手术条件评为“优”，一例评为“可接受”。术后舒芬太尼用量较低（通过患者自控镇痛（PCA）为36 - 83μg）。并发症包括一例手术部位裂开（需要再次手术）和短暂头晕。
这种三联阻滞技术为高危髋部骨折患者或有脊麻禁忌症的患者提供了全面的镇痛，能够促进早期活动并减少对阿片类药物的依赖。需要更大规模的随机试验来证实这些发现。
