Ojective To compare the efficacy of continuous pericapsular nerve group block (PENGB) and continuous fascia iliaca compartment block (FICB) in the elderly undergoing total hip arthroplasty.
Methods Fifty patients undergoing total hip arthroplasty, 22 males and 28 females, aged 65-85 years, BMI 18-30 kg/m 2, ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups: the continuous PENGB group (group P) and the continuous FICB group (group F), 25 patients in each group. In group P, ultrasound-guided continuous PENGB was performed before induction of general anesthesia, and 0.375% ropivacaine 20 ml was administered. In group F, ultrasound-guided continuous FICB was performed before induction of general anesthesia, and 0.375% ropivacaine 30 ml was administered. Postoperatively, patients in both groups underwent patient-controlled nerve block analgesia. VAS pain scores at rest and movement (passive straight leg elevation for 45°) were recorded immediately before the nerve block, at 3, 6, 12, 24, and 48 hours after surgery. Assessment of patients with lower limb motor block at 12, 24, and 48 hours was graded using the modified Bromage score. The procedure time of the nerve block, the intraoperative consumption of propofol and remifentanil, postoperative remedial analgesia, length of stay before the operation, postoperative length of stay, nausea and vomiting, local anesthetic intoxication, nerve injury, catheter displacement and prolapse, hematoma, puncture site infection, and other adverse conditions were recorded.
Results Compared with the VAS pain scores immediately before the nerve block, the VAS pain scores at rest and movement 3, 6, 12, 24, and 48 hours after surgery were significantly lower in both groups (P < 0.05). In both groups, the VAS scores at movement were lower in group P than those in group F 6 and 12 hours after surgery (P < 0.05). The lower limb motor block modified Bromage scores 12, 24, and 48 hours after surgery were lower in group P than those in group F (P < 0.05). The onset of nerve block of group P took less time than that of group F (P < 0.05). There were no statistically significant differences in the propofol and remifentanil consumption, postoperative remedial analgesia, length of stay before the operation, and postoperative length of stay between the two groups. No adverse conditions such as nausea and vomiting, local anesthetic intoxication, nerve injury, catheter displacement or prolapse, hematoma, or puncture site infection occurred in either group.
Conclusion Both the continuous pericapsular nerve group block and the continuous fascia iliaca compartment block can consistently alleviate perioperative pain in the elderly undergoing total hip arthroplasty, while the continuous pericapsular nerve group block is more capable of reducing patients' active pain and preserving lower limb muscle strength, which is beneficial to patients' early postoperative recovery. |
