Supra-inguinal fascia iliaca block versus peri-capsular nerve group (PNEG) block for pain management in patients with hip fracture: A double-blind randomised comparative trial

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-10-08 DOI:10.1016/j.injury.2024.111936
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Abstract

Background

Regional analgesia has been recommended to alleviate pain caused by hip fractures. Both the supra-inguinal fascia iliaca block (S-FIB) and the peri‑capsular nerve group (PENG) block provide better analgesia than conventional fascia iliaca block for patients with hip fractures, but which one is superior remains equivocal. This study aimed to determine the superiority of S-FIB or PENG block for patients awaiting hip surgery.

Methods

In this prospective, double-blind, randomised comparative trial, patients with hip fractures awaiting operation were randomly allocated to receive either S-FIB with 30 ml 0.35 % ropivacaine or PENG block with 20 ml 0.35 % ropivacaine. Primary outcomes were pain scores (numeric rating scale, NRS, 0–10) at rest and during passive movement 30 min after nerve block. Secondary outcomes included pain scores at rest and during movement 10 and 20 min after nerve block and during positioning for spinal anaesthesia, time spent for performing nerve block and spinal anaesthesia, and the quality of positioning for spinal anaesthesia.

Results

One-hundred patients were enrolled and 91 patients completed the trial (S-FIB group n = 46, PENG group n = 45). No significant difference was noted between these two groups in the pain scores (median [interquartile range]) either at rest (0 [0–0] vs 0 [0–0], P = 0.151) or during passive movement (3 [[1], [2], [3], [4], [5], [6]] vs 3 [[2], [3], [4], [5]], P = 0.99) at 30 min after nerve block. However, within-group analysis revealed that a significant reduction in pain score at rest was noted as early as 20 min after PENG block while that was noted only at 30 min after S-FIB. In addition, less time was required to perform PENG than S-FIB the block (3.1 [2.3–3.9] vs. 4.6 [3.1–5.6] minutes, P < 0.001).

Conclusions

Our result suggests that with a lower dose of local anaesthetic, a shorter procedure time and earlier analgesic effect, PENG block may be preferred to S-FIB for patients with hip fracture awaiting surgery.
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髂腹股沟上筋膜阻滞与囊周神经群 (PNEG) 阻滞治疗髋部骨折患者疼痛:双盲随机对比试验
背景区域镇痛被推荐用于减轻髋部骨折引起的疼痛。对于髋部骨折患者,腹股沟上髂筋膜阻滞(S-FIB)和囊周神经群阻滞(PENG)都能提供比传统髂筋膜阻滞更好的镇痛效果,但孰优孰劣仍不明确。在这项前瞻性、双盲、随机比较试验中,等待手术的髋部骨折患者被随机分配接受 30 毫升 0.35 % 罗哌卡因的 S-FIB 或 20 毫升 0.35 % 罗哌卡因的 PENG 阻滞。主要结果是神经阻滞后 30 分钟休息时和被动运动时的疼痛评分(数字评分量表,NRS,0-10)。次要结果包括神经阻滞后 10 分钟和 20 分钟休息和运动时的疼痛评分,以及脊髓麻醉定位时的疼痛评分,进行神经阻滞和脊髓麻醉所花费的时间,以及脊髓麻醉定位的质量。结果 100 名患者参加了试验,91 名患者完成了试验(S-FIB 组 46 人,PENG 组 45 人)。两组患者在神经阻滞后 30 分钟的疼痛评分(中位数[四分位数间距])方面无明显差异,无论是静止时(0 [0-0] vs 0 [0-0],P = 0.151)还是被动运动时(3 [[1]、[2]、[3]、[4]、[5]、[6]] vs 3 [[2]、[3]、[4]、[5]],P = 0.99)。不过,组内分析显示,PENG阻滞后20分钟,静息时的疼痛评分就显著降低,而S-FIB阻滞后30分钟,疼痛评分才显著降低。结论我们的结果表明,对于等待手术的髋部骨折患者来说,PENG阻滞比S-FIB阻滞所需的局麻药剂量更低、手术时间更短、镇痛效果更早,可能是首选。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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