Baran Onur, Şahin Ayhan, Arar Cavidan
Department of Anesthesiology and Reanimation, Medical Faculty of Tekirdağ Namık Kemal University, Kampüs Cd. No: 1, Süleymanpaşa, Tekirdağ, 59100, Türkiye.
J Orthop Surg Res. 2025 Aug 6;20(1):729. doi: 10.1186/s13018-025-06055-w.
Effective postoperative pain management is essential for recovery after total hip arthroplasty. While opioids are commonly used, their adverse effects necessitate alternative strategies. Peripheral nerve blocks are increasingly utilized, including the pericapsular nerve group block and the supra-inguinal fascia iliaca compartment block. However, comparative data on their efficacy remain limited. This randomized controlled trial evaluated the analgesic effectiveness of these two techniques. The primary outcome was postoperative pain scores at rest and with movement. Secondary outcomes included opioid consumption, the need for rescue analgesia, and hemodynamic stability.
Sixty patients undergoing total hip arthroplasty under general anesthesia were randomly assigned to receive either a pericapsular nerve group block or a supra-inguinal fascia iliaca compartment block. Standardized ultrasound-guided techniques were used with equal volumes of local anesthetic. Pain scores were assessed postoperatively using the Visual Analog Scale. Opioid consumption and rescue analgesia use were recorded for twenty-four hours.
At 12 and 24 h postoperatively, median VAS scores at rest and during movement were significantly lower in the PENG group (≤ 2.0) compared to the SIFICB group (> 4.0) (P < 0.001). Opioid consumption in the first 24 h was significantly lower in the PENG group (11.1 ± 1.5 mg morphine equivalents) than in the SIFICB group (18.4 ± 2.5 mg; P < 0.001). Hemodynamic parameters were stable, with no significant complications.
The pericapsular nerve group block provided superior analgesia and reduced opioid consumption compared to the supra-inguinal fascia iliaca compartment block. It should be considered a practical component of multimodal pain management for total hip arthroplasty.
Ethics Committee of Tekirdağ Namık Kemal University (2023.06.01.06).
https://clinicaltrials.gov (NCT06806865).
有效的术后疼痛管理对于全髋关节置换术后的恢复至关重要。虽然阿片类药物常用，但其不良反应促使人们寻求替代策略。周围神经阻滞的应用越来越多，包括关节周围神经群阻滞和腹股沟上髂筋膜腔隙阻滞。然而，关于它们疗效的比较数据仍然有限。这项随机对照试验评估了这两种技术的镇痛效果。主要结局是静息和活动时的术后疼痛评分。次要结局包括阿片类药物消耗量、急救镇痛需求和血流动力学稳定性。
60例在全身麻醉下接受全髋关节置换术的患者被随机分配接受关节周围神经群阻滞或腹股沟上髂筋膜腔隙阻滞。采用标准化超声引导技术，使用等量的局部麻醉剂。术后使用视觉模拟量表评估疼痛评分。记录24小时内的阿片类药物消耗量和急救镇痛使用情况。
术后12小时和24小时，关节周围神经群阻滞组（PENG组，≤2.0）静息和活动时的视觉模拟量表（VAS）评分中位数显著低于腹股沟上髂筋膜腔隙阻滞组（SIFICB组，>4.0）（P<0.001）。PENG组24小时内的阿片类药物消耗量（11.1±1.5毫克吗啡当量）显著低于SIFICB组（18.4±2.5毫克；P<0.001）。血流动力学参数稳定，无明显并发症。
与腹股沟上髂筋膜腔隙阻滞相比，关节周围神经群阻滞提供了更好的镇痛效果并减少了阿片类药物的消耗量。它应被视为全髋关节置换术多模式疼痛管理的一个实用组成部分。
泰基尔达·纳米克·凯末尔大学伦理委员会（2023.06.01.06）。
