囊周围神经阻滞与腰方肌前路阻滞在髋部骨折手术中的比较：随机临床试验超

贵州医科大学    麻醉与心脏电生理课题组

翻译：王波          编辑：王波          审校：曹莹


目的
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本研究在全髋关节置换术(THA)患者中，比较了囊周围神经组(Peng)联合股外侧皮神经(LFCN)阻滞和腰方肌前路阻滞(QLB)的效果。

方法


在这项前瞻性的双盲试验中，80名成人在腰麻下接受全髋关节置换术(n=40)，分别接受前路QLB术(n=40)和Peng+LFCN阻滞(n=40)，其中Peng组和LFCN组分别为Peng组和LFCN组，其中Peng组和LFCN组分别使用25mL0.25%布比卡因和5mL布比卡因。主要结果是术后24小时静脉注射吗啡的累积消耗量。次要结果包括疼痛评分、股四头肌力量、患者满意度和副作用。

结果


【罂粟摘要】囊周围神经阻滞与腰方肌前路阻滞在髋部骨折手术中的比较：随机临床试验超

在前12小时内，两组在吗啡用量或疼痛评分方面没有显著差异(p>；0.05)。在24小时后，彭氏+LFCN组的吗啡消耗量(p=0.027)和静息视觉模拟评分(p<；0.001)均显著降低。15%(6/40)的患者在术后6小时出现股四头肌无力(P=0.026)，而在术后24小时内，彭氏+腰椎前路组未见股四头肌无力。患者满意度和并发症发生率在两组之间具有可比性。


结论


      前路QLB和Peng+LFCN均可提供持续12小时的有效止痛效果。然而，Peng+LFCN组合提供了更长的止痛时间，减少了阿片类药物的需求，并更好地保存了股四头肌的力量。

原始文献来源：Aslan M, Kilicaslan A, Gök F, Kekec AF, Colak TS. Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial. Braz J Anesthesiol. 2025 May 23;75(5):844643. doi: 10.1016/j.bjane.2025.844643. Epub ahead of print. PMID: 40414494; PMCID: PMC12182778.

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Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial

Objective: This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). 

Methods: In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects. 

Results: No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups. 

Conclusion: Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.

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