Preoperative Analgesia Efficacy of Liposomal Bupivacaine Following Pericapsular Nerve Group (PENG) Block in Patients with Hip Fracture: A Randomized Controlled Observer-Blinded Study.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2025-02-01 Epub Date: 2024-12-03 DOI:10.1007/s40122-024-00683-6

Haobin Peng, Jiajun Wen, Manli Chen, Zhengyuan Xia, Ying Jiang, Kaiqi Xie, Weitao Huang, Bangsheng Cui, Peixing Li, Yiwen Zhang, Xianping Wu

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Abstract

Introduction: Single-injection pericapsular nerve group (PENG) block with ropivacaine provides clear analgesic effects in preoperative pain management for hip fractures. However, it suffers from insufficient duration, failing to meet the needs of most patients. This single-center, randomized controlled, observer-blinded trial utilizes a novel combination of liposomal bupivacaine (LB) single-injection PENG block to examine its efficacy, duration, and safety in preoperative analgesia for hip fractures, aiming to develop a new preoperative analgesic protocol.

Methods: Sixty-six patients with hip fractures received ultrasound-guided single-injection PENG block with LB or ropivacaine after admission. The primary outcome was the static and dynamic pain scores measured at 48 h post-block. Pain scores at 12, 24, 36, 60, and 72 h post-block, rescue analgesia rate, time to first opioid, additional morphine consumption, and adverse events were assessed as the secondary outcomes.

Results: LB versus ropivacaine group at 48 h post-block, with a median interquartile range (IQR) of 2 (1.0-2.0) versus 3 (2.0-3.0) at static pain score and 2 (1.75-3.0) versus 4 (4.0-5.0) at dynamic pain score. LB group had lower dynamic and static pain scores at other observation points except for the static pain score at 72 h, lower pain intensity [sum of pain intensity difference (SPID)_0-24, SPID_0-48 and SPID_0-72], longer time to first opioid, lower additional morphine consumption, and lower incidence of nausea and vomiting. No significant inter-group differences were detected in other secondary outcomes.

Conclusions: For preoperative analgesia of hip fractures, LB single-injection PENG block had a similar analgesic intensity and safety as ropivacaine but provided a longer duration of analgesia, reaching 48 h and even extending beyond 60 h, which reduced opioid consumption and extended time to the first opioid.

Trial registration: The protocol was registered in www.chictr.org.cn under the identifier ChiCTR2300072939.

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髋部骨折患者囊包神经阻滞后布比卡因脂质体的术前镇痛效果：一项随机对照观察-盲法研究。

罗哌卡因单次注射囊周神经阻滞（PENG）在髋部骨折术前疼痛管理中具有明显的镇痛效果。然而，它的持续时间不足，不能满足大多数患者的需求。这项单中心、随机对照、观察者盲法试验采用新型布比卡因脂质体（LB）单次注射PENG阻断剂联合应用，研究其在髋部骨折术前镇痛中的疗效、持续时间和安全性，旨在制定一种新的术前镇痛方案。方法：66例髋部骨折患者入院后接受超声引导下单次注射用LB或罗哌卡因进行PENG阻滞。主要终点是阻滞后48小时的静态和动态疼痛评分。将阻滞后12、24、36、60和72小时的疼痛评分、镇痛率、首次使用阿片类药物的时间、额外吗啡消耗和不良事件作为次要结局进行评估。结果：阻滞后48 h LB组与罗哌卡因组相比，静态疼痛评分中位数四分位数范围（IQR）为2（1.0-2.0）对3(2.0-3.0)，动态疼痛评分中位数四分位数范围为2（1.75-3.0）对4（4.0-5.0）。LB组除72 h静态疼痛评分外，其他观察点动态和静态疼痛评分均较低，疼痛强度[疼痛强度差值（SPID）0-24、SPID0-48和SPID0-72]较低，第一阿片类药物使用时间较长，吗啡额外用量较低，恶心呕吐发生率较低。其他次要结局组间无显著差异。结论：对于髋部骨折术前镇痛，LB单次注射PENG阻滞具有与罗哌卡因相似的镇痛强度和安全性，但镇痛持续时间更长，可达48 h，甚至超过60 h，减少了阿片类药物的消耗，延长了到第一阿片类药物的时间。试验注册：该方案在www.chictr.org.cn上注册，标识符为ChiCTR2300072939。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.