超声引导下囊周神经阻滞用于髋关节手术：左旋布比卡因与左旋布比卡因加地塞米松的随机对照试验

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


背景
背景jbhb

由于阿片类药物的不良反应和传统神经阻滞的局限性，接受髋部骨折手术的老年患者围手术期有效的疼痛控制仍然是一个挑战。超声引导下的包膜周围神经阻滞(Peng)可提供靶向止痛，并伴有最小程度的运动阻滞，支持早期活动。本研究比较了0.5%左旋布比卡因单用与地塞米松联合用于Peng阻滞的镇痛效果。

方法


在这项前瞻性、随机、双盲对照试验中，44名计划在脊麻下接受择期髋部骨折手术的成年患者被分成两组。L组注入0.5%左旋布比卡因20mL，LD组注入等量地塞米松8 mg。主要结果是首次抢救止痛的时间。次要结果包括静息和运动时的数字评定量表(NRS)评分、术后48小时内阿片类药物的总消耗量、腰麻位置的简易性、血流动力学稳定性和麻醉师满意度。

结果

【罂粟摘要】超声引导下囊周神经阻滞用于髋关节手术：左旋布比卡因与左旋布比卡因加地塞米松的随机对照试验

共有50名患者接受了资格评估，其中44名符合纳入标准，并被随机分为两组(L组：22例；LD组：22例)。按方案分析42例患者(每组21例)。两组之间的人口统计特征具有可比性。LD组首次镇痛时间(15.00±2.67h)和第二次镇痛时间(25.50±3.73h)明显长于L组(分别为6.38±1.24h和12.29±2.80h，p<；0.001)。地塞米松组在术后所有时间段的静息和运动时疼痛评分持续较低。LD组阿片类药物总用量显著减少。LD组的麻醉师满意度得分显著高于LD组(p=0.013)。副作用特征相似，L组只有一名患者出现恶心。两组患者的脊柱定位评分相似，均未出现运动障碍。两组间步行能力差异无统计学意义(p=1.000)。


结论


      地塞米松与左旋布比卡因联合应用可显著提高术后镇痛效果，方便患者体位调整，减少阿片类药物用量，在不影响安全性的前提下提高总体满意度。对于接受髋关节手术的老年患者来说，这一组合可能被认为是一种更好的止痛策略。

原始文献来源：Hoda W, Raj M, Oraon P, Kumari N, Lakra A, Hessa C, Kishore K, Lakra L. Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Comparing Levobupivacaine Alone Versus Levobupivacaine With Dexamethasone. Cureus. 2025 May 21;17(5):e84568. doi: 10.7759/cureus.84568. PMID: 40546588; PMCID: PMC12180687.

Ultrasound-Guided Pericapsular Nerve Group Block for Hip Surgery: A Randomized Controlled Trial Comparing  evobupivacaine Alone Versus Levobupivacaine With  examethasone

Background：Effective perioperative pain control in elderly patients undergoing hip fracture surgery remains a challenge due to the adverse effects of opioids and limitations of conventional nerve blocks. The ultrasound-guided pericapsular nerve group (PENG) block offers targeted analgesia with minimal motor blockade, supporting early mobilization. This study evaluates the analgesic efficacy of 0.5% levobupivacaine alone versus in combination with dexamethasone for PENG block. 

Methods： In this prospective, randomized, double-blinded controlled trial, 44 adult patients scheduled for elective hip fracture surgery under spinal anesthesia were allocated into two equal groups. Group L received 20 mL of 0.5% levobupivacaine, while group LD received the same volume with 8 mg of dexamethasone. The primary outcome was the time to first rescue analgesia. Secondary outcomes included Numerical Rating Scale (NRS) scores at rest and movement, total opioid consumption in the first 48 hours postoperatively, ease of positioning for spinal anesthesia, hemodynamic stability, and anesthesiologist satisfaction. 

Results： A total of 50 patients were assessed for eligibility, with 44 meeting the inclusion criteria and randomized equally into two groups (group L: 22; group LD: 22). The per-protocol analysis included 42 patients (21 in each group). Demographic characteristics were comparable between the groups. Group LD demonstrated a significantly prolonged time to first rescue analgesia (15.00 ± 2.67 hours) and second rescue analgesia (25.50 ± 3.73 hours) compared to group L (6.38 ± 1.24 hours and 12.29 ± 2.80 hours, respectively; p < 0.001). Pain scores were consistently lower at rest and during movement in the dexamethasone group at all postoperative intervals. Total opioid consumption was significantly reduced in group LD. Anesthesiologist satisfaction scores were significantly higher in group LD (p = 0.013). Side effect profiles were similar, with only one patient in Group L experiencing nausea. Both groups had comparable Ease of Spinal Positioning scores and showed no occurrence of motor blockade. Ambulation was not significantly different between the groups (p = 1.000). 

Conclusion：The addition of dexamethasone to levobupivacaine in PENG block significantly enhances postoperative analgesia, facilitates patient positioning, reduces opioid requirements, and improves overall satisfaction without compromising safety. This combination may be considered a superior analgesic strategy in elderly patients undergoing hip surgery.

END