DOES PERICAPSULAR ANESTHETIC BLOCK IMPROVE THE POSTOPERATIVE PERIOD IN TRANSTROCHANTERIC FRACTURES?

ABSTRACT Objective: To evaluate pain and mobility in patients with transtrochanteric fractures subjected to osteosynthesis with pericapsular nerve group (PENG) block and compare with patients who did not receive the block. Methods: The medical records of 49 patients were analyzed and data were collected regarding: age, gender, anesthetic evaluation, cause of trauma, locomotion, fracture classification, type of anesthesia used, anesthetic technique, pain, opioid administration and mobility with partial load. Results: Out of 49 patients, 17 (34.7 %) received PENG block. After surgery, most patients complained of pain and opioids were administered (67.3 %), with greatest frequency in the group without PENG block (93.3 %). Most patients who received PENG block walked within 6 h after surgery (52.9 %) and all recovered the ability to walk until hospital discharge (48 h), different from the group that did not receive PENG block (p = 0.012). The groups showed a significant difference between them regarding the frequency of reports of moderate to severe pain (p = 0.003). Conclusion: The use of PENG block in patients with transtrochanteric fractures subjected to osteosynthesis can help to reduce postoperative pain, early mobility with partial load and less use of opioids. Level of Evidence III, Retrospective Comparative Study.

摘要 研究目的：评估接受囊周神经丛（pericapsular nerve group, PENG）阻滞的转子间骨折患者行内固定术后的疼痛与运动功能，并与未接受该阻滞的患者进行对比。
研究方法：回顾性分析49例患者的病历资料，收集的临床数据包括：年龄、性别、麻醉评估、创伤原因、肢体活动状态、骨折分型、所用麻醉方式、麻醉操作技术、疼痛情况、阿片类药物使用情况及部分负重运动能力。
研究结果：49例患者中，17例（34.7%）接受了PENG阻滞。术后多数患者主诉疼痛并需使用阿片类药物（67.3%），其中未接受PENG阻滞组的占比达93.3%。接受PENG阻滞的患者中，52.9%可在术后6小时内下床行走，且全部患者在出院前（48小时内）恢复行走能力，与未接受PENG阻滞组存在显著统计学差异（p=0.012）。两组患者中度至重度疼痛的报告频率存在显著统计学差异（p=0.003）。
研究结论：转子间骨折内固定患者术中应用PENG阻滞，可有效降低术后疼痛程度、促进早期部分负重下床活动，并减少阿片类药物的使用量。
证据等级：Ⅲ级，回顾性对照研究。