在患有骨骨折的老年患者中阻断PENG:少是多吗? 一个前性的观察单心研究
Valerio Donatiello1, Aniello Alfieri2, Maria Civita Mazza2
1Department of Anesthesiology, V.Le Antonio Cardarelli 9, A.O.R.N. Antonio Cardarelli, 80131, Naples, Italy. valerio.donatiello@gmail.com.
Journal of anesthesia, analgesia and critical care
|July 18, 2025
概括
使用0.25%罗皮瓦卡因的PEricapsular神经群 (PENG) 阻塞为老年关节骨折患者提供有效的疼痛缓解. 这种度与较高剂量一样安全和有效,减少了阿片类药物需求.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 整形外科手术 整形外科手术
背景情况:
- 靠近大腿骨骨折在老年人中很常见,导致显著的发病率和死亡率.
- 有效的术后疼痛管理对于减少并发症和改善患者的治疗结果至关重要.
- PEricapsular神经群 (PENG) 块提供运动节约性止痛,有助于早期康复,但较高的局部麻醉剂 (LA) 剂量会在脆弱的患者中带来毒性风险.
研究的目的:
- 评估两种罗皮瓦卡因度 (0.375%与0.25%) 的止痛效果和安全性,用于接受近端股骨骨折手术的老年患者的PENG块.
- 确定PENG块中较低度的罗皮瓦卡因是否可以提供可比的疼痛缓解,同时最大限度地降低全身毒性风险.
主要方法:
- 一项前性观察性研究包括217名患有近端大腿骨骨折的老年患者 (65-100岁).
- 在脊柱麻醉之前,患者接受了20毫升的PENG阻塞,其中0.375%或0.25%的罗皮瓦卡因.
- 主要终点是需要吗啡救援的患者比例,次要结果包括到第一个救援剂量的时间.
主要成果:
- 在0.375%组中的23%患者和0.25%组中的25%患者需要吗啡救援 (p=0.87).
- 该研究表明,0.25%的罗皮瓦卡因组的非劣势,差异为-0.019 (95%CI: -0.0344至-0.0036).
- 两组之间在第一次救援吗啡剂量的时间上没有发现显著差异.
结论:
- 与0.25%的罗皮瓦卡因进行PENG阻断,与0.375%的罗皮瓦卡因相比,在老年人近端股骨骨折手术中提供非劣质止痛.
- 较低度支持其用于减少阿片类药物依赖,并尽量减少局部麻醉剂系统毒性的风险在这个脆弱的人群.
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