背景:全髋关节置换术(THA)是最常见的手术方法之一。由于髋关节的复杂神经支配以及最近在神经阻滞后保持运动功能的愿望,控制THA后的术后疼痛仍然是一个挑战。过去,几种神经阻滞技术已用于THA,但是腰方肌(QL)阻滞和囊周围神经组(PENG)阻滞已经成为保留阿片类药物的区域麻醉技术,可以保持运动功能.迄今为止,比较这两种区块技术的数据很少。我们研究的目的是比较这些技术在接受原发性THA的患者中的结果。
方法:这项回顾性分析利用了在我们机构接受原发性THA的三个不同组的数据:45例接受PENG阻滞的患者,38例接受QL阻滞的患者,和77名对照患者。由授权人员进行图表审查分析,以获得术后24和48小时的累积口服吗啡当量(OME)数据(主要结果)。此外,麻醉后监护病房(PACU)和12、24和48小时的视觉模拟疼痛评分(VAS)评分,步行距离,并获得住院时间数据(次要结局).使用方差分析(ANOVA)对参数数据进行Tukey的多重比较检验,或使用Krustal-Wallis对非参数终点进行Dunn的多重比较检验进行组比较。
结果:这项研究发现,在24和48小时,所有组的累积OME使用量均有统计学上的显着差异。QL和对照以及PENG和对照之间的OMEs存在显着差异;但是,在两个时间点,PENG组和QL组的OMEs均无差异.PACU中的VAS评分在所有组之间存在统计学上的显着差异;与PENG和对照组相比,QL显示PACU中的VAS评分显着降低,而PENG仅显示VAS评分明显低于对照组。所有组24小时的VAS评分在统计学上有显著差异;然而,仅QL在24小时显示VAS评分显著低于对照组.与PENG相比,QL与住院时间的统计学显着增加相关。
结论:本研究显示,原发性THA接受PENG或QL神经阻滞的患者使用OME无差异。组间的VAS评分相似,但在PACU中QL优于PENG。对于接受THA的患者,通过多途径策略优化术后疼痛仍应优先考虑。未来的研究是必要的,以便为这些患者提供最佳实践的指导。
BACKGROUND: Total hip arthroplasty (THA) is one of the most common operative procedures performed. Controlling postoperative pain following THA remains a challenge due to the complex innervation of the hip joint and the recent desire to preserve motor function following nerve blockade. Several nerve block techniques have been used for THA in the past, but the quadratus lumborum (QL) block and the blockade of the pericapsular nerve group (PENG) have emerged as opiate-sparing regional anesthesia techniques that preserve motor function. To date, little data comparing the two block techniques exists. The purpose of our study was to compare outcomes following these techniques in patients undergoing primary THA.
METHODS: This retrospective analysis utilized data from three distinct groups who underwent primary THA at our institution: 45 patients who received PENG block, 38 patients who received QL block, and 77 control patients. Chart review analysis was performed by authorized personnel to obtain cumulative oral morphine equivalent (OME) data at 24 and 48 hours postoperatively (primary outcomes). In addition, visual analog pain scale (VAS) scores in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours, ambulation distance, and length of hospital stay data were obtained (secondary outcomes). Group comparisons were conducted using either analysis of variance (ANOVA) with Tukey\'s multiple comparison test for parametric data or Krustal-Wallis with Dunn\'s multiple comparison tests for nonparametric endpoints.
RESULTS: This study found a statistically significant difference in cumulative OME usage across all groups at 24 and 48 hours. Significant difference in OMEs was found between QL and control and PENG and control; however, no difference was found in OMEs between PENG and QL groups at either time point. There was a statistically significant difference in VAS scores in the PACU across all groups; QL showed significantly lower VAS scores in the PACU compared to PENG and control, while PENG only showed significantly lower VAS scores compared to control. There was a statistically significant difference in VAS scores at 24 hours across all groups; however, only QL showed significantly lower VAS scores compared to control at 24 hours. QL was associated with a statistically significant increase in the length of hospital stay compared to PENG.
CONCLUSIONS: This study showed no difference between OME usage in patients who received PENG or QL nerve blocks for primary THA. VAS scores were similar between groups with the exception of QL outperforming PENG in the PACU. Optimizing postoperative pain via multi-approach strategies should remain a priority for patients undergoing THA. Future research is warranted in order to provide guidance on best practice for these patients.