超声引导下囊周神经群阻滞与局部浸润镇痛用于全髋关节置换术后镇痛效果比较的前瞻性随机对照研究

Comparison between ultrasound-guided pericapsular nerve group block and local infiltration analgesia for postoperative analgesia after total hip arthroplasty:a prospective randomized controlled trial

目的比较超声引导下囊周神经群(pericapsular nerve group,PENG)阻滞与关节周围局部浸润镇痛用于全髋关节置换术(total hip arthroplasty,THA)后的镇痛效果。方法本研究为前瞻性、双盲、随机对照试验。60例在全麻下接受初次,单侧THA的患者被随机分为PENG组或浸润组。PENG组患者在术前接受PENG阻滞,浸润组患者在术中接受局麻药关节周围局部浸润镇痛。主要指标为用于术后补救镇痛的盐酸吗啡消耗量。次要指标为术后疼痛视觉模拟评分(visual analogue scale,VAS),术后髋关节功能(包括髋关节屈曲活动度,每日行走距离),住院时间和并发症发生率。结果本研究的两组患者术后0~24 h,吗啡消耗量与术后总吗啡消耗量差异无统计学意义。两组患者术后静息VAS评分差异无统计学意义,浸润组患者术后12 h内的运动VAS评分显著更低。两组患者术后髋关节功能,住院时间和并发症发生率差异无统计学意义。结论作为一种新型的神经阻滞,PENG阻滞用于THA的镇痛效果并不优于关节周围局部浸润镇痛。局部浸润镇痛仍然是THA术后的首选镇痛方式。

Objective To compare the analgesic effect of ultrasound-guided pericapsular nerve blocking group(PENG)and periarticular local infiltration analgesic group after total hip arthroplasty(THA).Methods This study was a prospective,double-blind,randomized controlled trial(RCT).Sixty patients who underwent primary,unilateral total hip arthroplasty under general anesthesia were randomly divided into the PENG group and the infiltration group.Patients in the PENG group received peri-capsular nerve block under ultrasound guidance before surgery,and patients in the infiltration group received local anesthetics for peri-articular infiltrative analgesia during surgery.The main index was the consumption of morphine hydrochloride for postoperative analgesia.Secondary measures were postoperative VAS pain score,postoperative hip function(including range of motion of hip flexion,daily walking distance),length of hospital stay,and complication rate.Results There were no significant differences between the two groups in morphine consumption during the first 0-24 hours postoperatively,and the total postoperative morphine consumption.There were no significant differences between the two groups in the postoperative resting VAS pain scores.The exercise VAS score within 12 hours after surgery was significantly lower in the infiltration group.There were also no significant differences between the two groups in terms of postoperative hip function,length of hospital stay and complication rate.Conclusions As a new type of nerve blocking method,the analgesic effect of ultrasound-guided pericapsular nerve block for THA is not superior to periarticular local infiltration analgesia.Local infiltration analgesia remains the first option of analgesic modality after THA.