Ahmadzadeh Shahab, Schwab Hunter M, O'Dell Duplechin Mary, Broocks Kalob M, Hirsch Jon D, Drinkard Joseph, Shekoohi Sahar
Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA.
Neurol Int. 2025 Sep 8;17(9):142. doi: 10.3390/neurolint17090142.
Pediatric hip surgeries are associated with moderate to high levels of pain, which, in severe cases can lead to opioid prescription and use. There is a growing focus on reducing post-operative pain in these patients to decrease the need for opioids, as well as increase early mobilization for recovery. Conventional methods of pain relief using opioids can have unwanted negative impacts on pediatric patients such as respiratory depression, nausea, confusion, and the concerning possibility for the development of dependence. Likewise, traditional methods of anesthesia, like the lumbar epidural block, can have unwanted systemic side effects, such as hypotension, urinary retention, arrhythmias, and spinal abscesses. These complications can lead to longer hospital stays and delayed recovery. This review analyzes the efficacy of a newer regional anesthesia technique, the pericapsular nerve group (PENG) block, in comparison to the lumbar epidural block. This technique utilizes precision-based anesthesia to selectively block the articular branches to the hip joint while avoiding the main trunks of the femoral and obturator nerves. Additionally, with the utilization of high-resolution ultrasound to guide the blocks, providers can increasingly count on proper insertion and predictable anesthetic spread. The result is a motor-sparing blockade that shows promise in allowing earlier mobilization and better functional recovery times after pediatric hip surgeries.
小儿髋关节手术会带来中度到高度的疼痛，在严重情况下可能导致阿片类药物的处方和使用。人们越来越关注减轻这些患者的术后疼痛，以减少对阿片类药物的需求，并促进早期活动以利于恢复。使用阿片类药物的传统止痛方法可能会对小儿患者产生不良负面影响，如呼吸抑制、恶心、意识模糊以及令人担忧的成瘾可能性。同样，传统的麻醉方法，如腰段硬膜外阻滞，可能会产生不良的全身副作用，如低血压、尿潴留、心律失常和脊髓脓肿。这些并发症可能导致住院时间延长和恢复延迟。本综述分析了一种较新的区域麻醉技术——关节周围神经群（PENG）阻滞与腰段硬膜外阻滞相比的疗效。该技术利用精准麻醉选择性地阻断髋关节的关节支，同时避开股神经和闭孔神经的主干。此外，通过使用高分辨率超声引导阻滞，医护人员能够越来越多地确保正确进针和可预测的麻醉扩散。结果是一种保留运动功能的阻滞，有望使小儿髋关节手术后更早活动并缩短功能恢复时间。
