背景:包膜神经组(PENG)阻滞已被证明是一种有效的方法,可以减轻髋关节手术后的老年人疼痛并减少对阿片类药物的需求,具有可能的运动保护效果。到目前为止还没有报告,然而,已经描述了用于PENG阻滞的适当罗哌卡因体积。因此,本前瞻性随机对照研究旨在评估在进行髋关节置换术的老年人全身麻醉后使用三种不同体积的0.33%罗哌卡因进行PENG阻滞的股四头肌肌力和镇痛效果。
方法:在这项前瞻性随机双盲对照临床研究中,60例患者被随机分配接受超声引导下PENG阻滞,使用不同体积的罗哌卡因进行髋关节置换术。具体来说,这些患者给予10ml(A组,n=20),20ml(B组,n=20),或30毫升(C组,n=20)0.33%的罗哌卡因。在手术后6小时评估股四头肌肌力。在手术后4、6、12和24小时评估休息和运动时的视觉模拟量表(VAS)评分。阻止持续时间,不良事件发生率,并在术后24h评估患者满意度。
结果:手术后6小时股四头肌运动阻滞发生率为10ml,20毫升,30毫升组为5%,20%,75%,分别。手术后6小时股四头肌无力在30ml组中明显比其他组更为常见(p<0.001)。在所有时间点,相对于20ml和30ml治疗组的患者,给予10ml0.33%罗哌卡因的患者在休息和运动时表现出显著更高的VAS疼痛评分(p<0.05)。当在手术后4、6、12和24小时比较20ml和30ml组时,没有观察到镇痛效果的明显差异。阻滞持续时间没有显著差异,满意,观察各组间不良事件发生率。
结论:20ml0.33%罗哌卡因组的运动功能保存优于30ml0.33%罗哌卡因组。相对于PENG阻滞期间接受10ml0.33%罗哌卡因的组,那些接受20毫升和30毫升体积0.33%罗哌卡因的老年患者在髋关节置换术后术后疼痛得到了更好的缓解.
BACKGROUND: The pericapsular nerve group (PENG) block has been shown to be an effective approach to alleviating pain and reducing the need for opioids among older adults following hip surgery, with possible motor-sparing effects. No reports to date, however, have described appropriate ropivacaine volumes for use in the context of PENG block. The present prospective randomized controlled
study was thus developed to assess the quadriceps muscle strength and analgesic efficacy associated with PENG block performed using three different volumes of 0.33% ropivacaine following general anesthesia in older adults undergoing hip arthroplasty.
METHODS: In this prospective randomized double-blind controlled clinical
study, 60 patients were assigned at random to undergo ultrasound-guided PENG block for hip arthroplasty using different volumes of ropivacaine. Specifically, these patients were administered 10 ml (Group A, n = 20), 20 ml (Group B, n = 20), or 30 ml (Group C, n = 20) of 0.33% ropivacaine. Quadriceps muscle strength was evaluated at 6 h post-surgery. Visual analog scale (VAS) scores at rest and with movement were assessed at 4, 6, 12, and 24 h post-surgery. Block duration, adverse event incidence, and patient satisfaction were evaluated at 24 h post-surgery.
RESULTS: Quadriceps motor block incidence rates at 6 h post-surgery in the 10 ml, 20 ml, and 30 ml groups were 5%, 20%, and 75%, respectively. Quadriceps muscle weakness at 6 h post-surgery was significantly more common in the 30 ml group relative to the others (p < 0.001). Patients administered 10 ml 0.33% ropivacaine exhibited significantly higher VAS pain scores at rest and with movement relative to those patients in the 20 ml and 30 ml treatment groups at all time points (p < 0.05). No apparent differences in analgesic efficacy were observed when comparing the 20 ml and 30 ml groups at 4, 6, 12, and 24 h post-surgery. No significant differences in block duration, satisfaction, or adverse event incidence were observed among groups.
CONCLUSIONS: The preservation of motor function in the 20 ml 0.33% ropivacaine group was superior to that in the 30 ml 0.33% ropivacaine group. Relative to the group that received 10 ml 0.33% ropivacaine during PENG block, those elderly patients administered 20 ml and 30 ml volumes of 0.33% ropivacaine experienced superior postoperative pain relief following hip arthroplasty.