【罂粟摘要】腰麻下初次全髋关节置换术前行囊周神经群 (PENG) 阻滞的患者恢复质量：一项随机对照观察者盲法试验

腰麻下初次全髋关节置换术前行囊周神经群 (PENG) 阻滞的患者恢复质量：一项随机对照观察者盲法试验

贵州医科大学 麻醉与心脏电生理课题组

翻 译：柏雪  

编 辑：柏雪  

审 校：曹莹

背景：囊周神经群 (PENG) 阻滞是一种新型区域麻醉技术，被认为是全髋关节置换术中保留有效运动的阻滞。最近的随机研究显示PENG 阻滞在全髋关节置换术中的镇痛效果出现相互矛盾的结果。

方法:我们进行了一项随机对照、观察者设盲的单中心优效性试验，比较了在腰麻下接受初次全髋关节置换术的患者中，PENG阻滞与未接受PENG阻滞的镇痛效果。所有受试者均接受由扑热息痛和塞来昔布组成的多模式镇痛。主要结果是通过 QoR-15 问卷测量的 24 小时恢复质量 (QoR)。

结果:共纳入受试者112人(每组56人)。与未接受 PENG 阻滞的受试者 (103 [97–112]) 相比，接受 PENG 阻滞的受试者 (132 [116–138]) 的 24 小时 QoR-15 评分中位数（四分位间距 [IQR]）更高，中位数差异为 26（95% 置信区间，18–31；P <0.001）。同样，PENG 阻滞组 48 小时的 QoR-15 更高，而 PENG 阻滞组术后 24 和 48 小时的阿片类药物使用明显降低。然而在任何时间点，我们没有发现疼痛评分、行走距离或止吐剂使用的显著差异。同时没有观察到任何与 PENG 阻滞相关的并发症。

结论：在包含扑热息痛和塞来昔布的多模式镇痛方案中加入 PENG 阻滞可提高患者恢复质量，并减少在腰麻下接受初次全髋关节置换术后患者对阿片类药物的使用量。

原始文献来源：Promil Kukreja, Vishal Uppal, Alexander M. Kofskey, et,al. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. British Journal of Anaesthesia, 130 (6): 773-779 (2023)

英文原文：

Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial

Abstract

Background: The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that has been proposed as an effective motor-sparing block for total hip arthroplasty. Recent randomised studies show conflicting results regarding the analgesic efficacy of the PENG block for total hip arthroplasty.

Methods: We conducted a randomised controlled observer-blinded single-centre superiority trial comparing the efficacy of the PENG block with no block for patients undergoing primary total hip arthroplasty under spinal anaesthesia. All subjects received multimodal analgesia consisting of paracetamol and celecoxib. The primary outcome was quality of recovery (QoR) at 24 h as measured by the QoR-15 questionnaire.

Results: A total of 112 participants (56 in each group) were included in the analysis. The median (inter-quartile range [IQR]) 24-h QoR-15 scores were higher in subjects who received a PENG block (132 [116-138]) compared with subjects who did not (103 [97-112]) with a median difference of 26 (95% confidence interval, 18-31; P<0.001). Similarly, QoR-15 at 48 h was higher in the PENG group, and opioid use at 24 and 48 h postoperatively was significantly lower in the PENG group.

However, we did not find significant differences in pain score, distance to ambulation, or anti-emetic use at any time point. We did not observe any PENG block-related complications.

Conclusion: Adding a PENG block to a multimodal analgesia regimen that includes paracetamol and celecoxib improves the quality of recovery and reduces opioid requirements for patients undergoing primary total hip arthroplasty under spinal anaesthesia.

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