BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been...BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.展开更多
髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前...髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前囊的神经,同时对股四头肌的肌力影响较小,符合加速康复外科的理念,倍受麻醉科医生关注。本文基于PENGB在髋部术后疼痛管理中的广泛应用,对2020年1月至2022年12月在国内外医学期刊数据库发表的随机对照试验(randomized controlled trial,RCT)和临床试验注册中心注册的在研临床试验进行检索汇总并进行前沿综述(state-of-the-art literature review,SotA),总结研究者共同关注的热点和研究方向。本综述共纳入14项已发表的RCT及30项在研临床试验,探讨了PENGB的多个研究方向,包括镇痛优势、对下肢肌力的影响、术后康复质量等。根据现有证据显示,PENGB是髋部术后疼痛管理的重要手段,在术后镇痛和康复方面具有明显优势,将成为促进髋部手术后患者康复的重要策略之一。展开更多
文摘BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
文摘髋部术后疼痛多为中重度,严重影响患者早期康复训练,进而影响患者整体康复进程。因此,髋部术后疼痛管理对患者康复质量至关重要。关节囊周围神经群阻滞(pericapsular nerve group block,PENGB)是一种新型的镇痛手段,能完全阻滞髋关节前囊的神经,同时对股四头肌的肌力影响较小,符合加速康复外科的理念,倍受麻醉科医生关注。本文基于PENGB在髋部术后疼痛管理中的广泛应用,对2020年1月至2022年12月在国内外医学期刊数据库发表的随机对照试验(randomized controlled trial,RCT)和临床试验注册中心注册的在研临床试验进行检索汇总并进行前沿综述(state-of-the-art literature review,SotA),总结研究者共同关注的热点和研究方向。本综述共纳入14项已发表的RCT及30项在研临床试验,探讨了PENGB的多个研究方向,包括镇痛优势、对下肢肌力的影响、术后康复质量等。根据现有证据显示,PENGB是髋部术后疼痛管理的重要手段,在术后镇痛和康复方面具有明显优势,将成为促进髋部手术后患者康复的重要策略之一。
