Angela Lucia Balocco, Nicolas Gautier, Sam Van Boxstael, Ana M López, Michele Carella, Kristoff Corten, Xavier Sala-Blanch, Admir Hadzic, Philippe Emmanuel Gautier
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引用次数: 0
摘要
背景:目前对囊周神经群(PENG)阻滞作用机制的了解主要基于尸体研究。我们对接受髋关节手术的患者进行了成像研究,以加深对 PENG 阻滞后镇痛机制的理解。材料和方法:10 名计划接受髋关节手术的患者在超声引导下接受了 PENG 阻滞,阻滞剂为 18 mL 0.5% 罗哌卡因混合 2 mL 造影剂。阻滞完成后,进行了高分辨率 CT 扫描,以获得注射剂弥散的三维重建结果:CT 成像显示,注射剂主要局限于髂骨外膜和腰肌,少量扩散到髋关节囊。所有患者的髂骨和/或腰肌内都检测到了造影剂。未观察到向会阴下平面或闭孔扩散的情况:我们的研究表明,PENG阻滞的镇痛效果可能与阻滞股神经在髂腰肌内的分支有关,而没有出现与闭孔神经阻滞相称的扩散模式:试验注册号:ClinicalTrials.gov Registry (NCT06062134)。
Pericapsular nerve group block: a 3D CT scan imaging study to determine the spread of injectate.
Background: Current understanding of the mechanism of action of the pericapsular nerve group (PENG) block is primarily based on cadaver studies. We performed an imaging study in patients undergoing hip surgery to enhance the understanding of the analgesic mechanisms following a PENG block.
Materials and methods: 10 patients scheduled for hip surgery received an ultrasound-guided PENG block with 18 mL of 0.5% ropivacaine mixed with 2 mL of a contrast agent. After completion of the block, a high-resolution CT scan was performed to obtain a three-dimensional reconstruction of the injectate's dispersion.
Results: The CT imaging revealed that injectate was mainly confined to the epimysium of the iliacus and the psoas muscle, with a minor spread to the hip capsule. Contrast dye was detected within the iliacus and/or the psoas muscle in all patients. No observed spread to either the subpectineal plane or the obturator foramen was detected.
Conclusion: Our study suggests that the analgesic effect of the PENG block may be related to the block of the branches of the femoral nerve traveling within the iliopsoas muscle without a spread pattern commensurate with the block of the obturator nerve.
期刊介绍:
Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.
Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).