The PENG Block in Elective Primary Anterior Total Hip Arthroplasty Is Associated with Reduced Length of Stay: A Multidisciplinary Prospective Randomized Double-Blinded Controlled Trial.

IF 4.4 1区医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-02-28 DOI:10.2106/JBJS.24.00825

Matthieu Hanauer, Alexander F Heimann, Pavel Kricka, Stefan Blümel, Darius Marti, Angela M Moosmann, Vlad Popa, Corinne A Zurmühle, Joseph M Schwab, Moritz Tannast

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Abstract

Background: The pericapsular nerve group (PENG) block has been shown to reduce pain and opioid consumption in posterior total hip arthroplasty (THA). The present study assessed the effects of the PENG block versus a placebo on postoperative (1) pain, (2) morphine consumption, and (3) length of stay in patients undergoing primary anterior THA.

Methods: This was an institutional review board-approved, single-center, parallel-group, prospective, randomized, double-blinded, controlled trial of patients undergoing primary anterior THA between June 2022 and April 2023. Both groups underwent ultrasound-guided injection of a 20-mL solution (0.5% ropivacaine in the PENG group, 0.9% NaCl in the placebo group), according to the PENG block procedure. Sixty patients were included (32 in the PENG group, 28 in the placebo group). We assessed (1) postoperative pain at 1, 6, 12, and 24 hours with use of the visual analogue scale; (2) total morphine consumption as the morphine-equivalent dose (MED) during the first 24 hours postoperatively; and (3) the length of stay in days.

Results: For the primary outcome, the median visual analogue scale pain score was 3.5 (range, 0 to 10) in the PENG group versus 4 (range, 0 to 10) in the placebo group at 1 hour postoperatively (p = 0.335); 1 (range, 0 to 7) versus 2 (range, 0 to 6) at 6 hours postoperatively (p = 0.306); 1 (range, 0 to 8) versus 1 (range, 0 to 6) at 12 hours postoperatively (p = 0.895); and 1.5 (range, 0 to 6) versus 1.5 (range, 0 to 6) at 24 hours postoperatively (p = 0.914). For secondary outcomes, the mean ± standard deviation 24-hour morphine consumption was 24 ± 17 MED in the PENG group versus 35 ± 29 MED in the placebo group (p = 0.110). The median length of stay was 2 days (range, 2 to 5 days) in the PENG group versus 4 days (range, 2 to 7 days) in the placebo group (p = 0.003).

Conclusions: In this trial, the PENG block showed a significant decrease in hospital length of stay; however, no significant difference was found for visual analogue scale pain scores or morphine consumption following primary anterior THA compared with a placebo.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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背景：在后全髋关节置换术（THA）中，囊周神经组（PENG）阻滞可减轻疼痛和阿片类药物的消耗。本研究评估了 PENG 阻滞与安慰剂相比对初次前路全髋关节置换术患者术后（1）疼痛、（2）吗啡消耗量和（3）住院时间的影响：这是一项经机构审查委员会批准的、单中心、平行组、前瞻性、随机、双盲、对照试验，对象是2022年6月至2023年4月间接受初次前路THA手术的患者。两组患者均在超声引导下按照PENG阻滞程序注射20毫升溶液（PENG组为0.5%罗哌卡因，安慰剂组为0.9%氯化钠）。共纳入 60 例患者（PENG 组 32 例，安慰剂组 28 例）。我们使用视觉模拟量表评估了(1)术后1、6、12和24小时的疼痛情况；(2)术后24小时内吗啡总用量，即吗啡当量剂量（MED）；以及(3)住院天数：就主要结果而言，术后 1 小时时，PENG 组的视觉模拟量表疼痛评分中位数为 3.5（范围为 0 至 10），而安慰剂组为 4（范围为 0 至 10）（P = 0.335）；PENG 组的视觉模拟量表疼痛评分中位数为 1（范围为 0 至 10），而安慰剂组为 4（范围为 0 至 10）（P = 0.335）。335）；术后 6 小时时，1 例（范围 0 至 7）对 2 例（范围 0 至 6）（p = 0.306）；术后 12 小时时，1 例（范围 0 至 8）对 1 例（范围 0 至 6）（p = 0.895）；术后 24 小时时，1.5 例（范围 0 至 6）对 1.5 例（范围 0 至 6）（p = 0.914）。在次要结果方面，PENG 组 24 小时吗啡消耗量的平均值（标准差）为 24 ± 17 MED，而安慰剂组为 35 ± 29 MED（P = 0.110）。PENG组的中位住院时间为2天（范围为2至5天），而安慰剂组为4天（范围为2至7天）（P = 0.003）：结论：在这项试验中，PENG阻滞显著缩短了住院时间；然而，与安慰剂相比，初级前路THA术后视觉模拟量表疼痛评分或吗啡用量没有发现显著差异：有关证据等级的完整描述，请参阅 "作者须知"。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.