全髋关节置换两种神经阻滞镇痛比较

Comparison of two nerve blocks for analgesia in total hip arthroplasty

摘要:

[目的] 比较关节囊周围神经群 （pericapsular nerve group, PENG） 阻滞与髂筋膜 （fascia iliaca compartment, FIC） 阻滞对全麻下全髋关节置换术后早期影响。[方法]2020 年 6 月—2021 年 9 月本院关节外科拟行全髋关节置换术的 109 例患者纳入本研究，随机分为两组，54 例采用 PENG 阻滞，另外 55 例采用 FIC 阻滞。比较两组临床和镇痛资料。[结果]两组手术时间、术中失血量、术中输液量的差异均无统计学意义（P＞0.05）。随术后时间延长，两组股四头肌肌力显著增加（P＜0.05），术后恶心及呕吐评分 （postoperative nausea and vomiting, PONV） 显著减少 （P＜0.05）。术后 12 h，PENG 组在肌力 [(4.1±0.7) vs (3.3± 0.5), P＜0.001]、PONV 评分 [(2.7±0.4) vs (4.6±0.5), P＜0.001]、疼痛 VAS 评分 [(2.5±0.6) vs (3.7±0.9), P＜0.001]、自控静脉镇痛泵（pa- tient-controlled intravenous analgesia, PCIA）使用次数 [(10.1±2.4) 次 vs (15.2±1.9) 次, P＜0.001] 均显著优于 FIC 组。[结论] 关节囊周围神经阻滞能够缓解全髋关节置换术后疼痛，减少阿片类药物的用量，镇痛效果优于髂筋膜间隙阻滞。

Abstract:

[Objective] To compare the early effects of pericapsular nerve group (PENG) block versus fascia iliaca compartment (FIC) block on total hip arthroplasty (THA) under general anesthesia. [Methods] A total of 109 patients who planned to undergo THA in the Department of Joint Surgery of our hospital from June 2020 to September 2021 were included in this study and randomly divided into two groups. Of them, 54 patients receiving PENG block, while other 55 patients receiving FIC block. The clinical and analgesic data of the two groups were compared. [Results] There were no significant differences in operation time, intraoperative blood loss and intraoperative infusion volume between the two groups (P＞0.05). As time elapsed postoperatively, quadriceps muscle strength was significantly increased (P＜ 0.05), whereas postoperative nausea and vomiting (PONV) score was decreased significantly in both groups (P＜0.05). The PENG group proved significantly superior to the FIC group 12 hours after surgery in terms of muscle strength [(4.1±0.7) vs (3.3±0.5), P＜0.001], PONV score [(2.7±0.4) vs (4.6±0.5), P＜0.001], pain VAS score [(2.5±0.6) vs (3.7±0.9), P＜0.001] and patient- controlled intravenous analgesia (PCIA) press times [(10.1±2.4) vs (15.2±1.9), P＜0.001]. [Conclusion] Periarticular capsular nerve block does effectively relieve pain, reduce the dosage of opioids, give better analgesic effect over the fascia iliaca compartment block block in THA.