减少罗皮瓦卡因体积与周围神经甲沙在PENG区块的全关节整形术:一个随机对照试验
Tomasz Reysner1, Agnieszka Neumann-Podczaska2, Pawel Pietraszek3
1Department of Palliative Medicine, Poznan University of Medical Sciences, Os. Rusa 55, 61-245 Poznań, Poland.
Journal of clinical medicine
|December 30, 2025
概括
在全关节整形术 (THA) 中,添加德克萨米他到低体积周囊神经群 (PENG) 阻断剂显著延长疼痛缓解,并降低阿片类药物的使用. 这种增强的PENG阻断保留了四头四的功能,提供了更安全,更有效的区域麻醉选择.
科学领域:
- 麻醉学 麻醉学
- 区域麻醉 区域麻醉
- 疼痛管理 疼痛管理
背景情况:
- 周囊神经组 (PENG) 阻断是全关节整形术 (THA) 多模式止痛的关键组成部分.
- 标准的大容量局部麻醉方案可能会导致运动功能障碍.
- 周围神经甲的添加可能会使体积减少,保持有效性并最大限度地减少四头骨的弱点.
研究的目的:
- 为了评估是否添加德克萨米他到低容量PENG阻断剂延长疼痛缓解,减少阿片类药物消耗,并保持运动功能与标准容量PENG阻断剂相比.
- 通过修改的PENG阻断技术来评估THA后的疼痛控制和四头肌强度.
主要方法:
- 随机对照试验 (NCT06470334) 涉及60名接受THA.治疗的成年患者.
- 组:标准体积PENG块 (20毫升0.2%罗皮瓦卡因) 与低体积PENG块与德克萨米 (10毫升0.2%罗皮瓦卡因+4毫克德克萨米).
- 主要结局:时间到首次救援阿片类药物;次要结局:48小时阿片类药物消费,疼痛评分 (NRS) 和四头肌强度.
主要成果:
- PENG + 德克萨米他松组显示,第一次服用阿片类药物的时间显著延长 (15.0 vs 9.1 h; p < 0.0001) 并减少了48小时的阿片类药物消费 (2.3 vs 5.0 mEQ; p = 0.0120).
- 疼痛评分在4小时后可比较,但在手术后8,12小时和24小时的PENG + 德甲组中较低 (p < 0.01).
- 在所有评估时间点 (p > 0.9999) 中,四头肌强度在两组中都完全保留.
结论:
- 将近神经甲松添加到低体积的PENG阻塞剂中,可提供延长的止痛效果,并降低阿片类药物需求.
- 这种技术保持了有效的疼痛控制和四头肌功能.
- 这种修改后的PENG阻断方法可能会提高THA患者区域麻醉的安全性和有效性.
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