Perikapsulāro nervu grupas (PENG) bloka efektivitāte pacientiem ar gūžas lūzumu, salīdzinot ar fascia iliaca blokādi
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Augšstilba kaula kakliņa lūzumi ir bieža trauma vecāka gadagājuma cilvēkiem, īpaši sievietēm, ko lielākoties ārstē ķirurģiski. Šī trauma ir saistīta ar izteiktām sāpēm, īpaši pie kustībām, tādēļ ir nepieciešams nodrošināt adekvātu atsāpināšanu gan pirms, gan pēc operācijas. Narkotiskajiem analgēzijas līdzekļiem un NSPIL ir daudz blakusparādību, tādēļ ir ieteicams izmantot papildus atsāpināšanas metodes, kas ietver reģionālās anestēzijas blokus.
Darba mērķis. Noskaidrot PENG un Fascia iliaca bloku ietekmi uz agrīnā pēcoperācijas perioda sāpju intensitāti un noskaidrot, vai, pēc perifēro nervu bloku pielietošanas, samazinās nepieciešamība pēc opioīdiem.
Materiāli un metodes. Mērķa īstenošanai tika veikts prospektīvs observācijas pētījums, kurā ievāca un analizēja datus par 30 pacientiem ar augšstilba kaula kakliņa lūzumu, kam tika veikta endoprotezēšana. Pētījumā iekļautie pacienti tika sadalīti divās grupās – tie, kas saņems PENG blokādi, un tie, kas saņems Fascia iliaca blokādi. Tika ievākti dati par pacienta sāpju intensitāti miera stāvoklī un pie kustībām pirms operācijas, operācijas dienā un pirmajā pēcoperācijas dienā, izmantojot VAS sāpju skalu. Tika sekots līdz morfīna patēriņam pēc operācijas, blakusparādību esamībai, miega kvalitātei un apmierinātībai ar pielietoto analgēziju.
Rezultāti. No 30 pētījumā iekļautiem pacientiem, 25 (83.3%) bija sievietes un pieci (16.7%) bija vīrieši. Vidēji sāpju intensitāte miera stāvoklī abu perifēro nervu bloku grupās bija par divām ballēm zemāka nekā pie kustībām. Sāpju intensitāte miera stāvoklī pirms operācijas un operācijas dienā Fascia iliaca bloka grupā bija par vienu balli augstāka nekā PENG bloka grupā. Sāpju intensitāte pie kustībām operācijas dienas pulksten 22:00 Fascia iliaca bloka grupā bija par divām ballēm augstāka nekā PENG bloka grupā. Pirmajā pēcoperācijas dienā sāpju intensitāte gan miera stāvoklī, gan pie kustībām abās grupā bija vienāda. Netika novērota statistiski nozīmīga atšķirība starp PENG un Fascia iliaca bloku grupām sāpju intensitātes samazināšanā, apmierinātībā ar pielietoto analgēziju un miega kvalitātē (p>0,05). Fascia iliaca bloka grupā morfīns bija nepieciešams 11 pacientiem, toties PENG bloka grupā tikai pieciem pacientiem. Nevienam no pētījumā iekļautiem pacientiem netika novērotas ar perifēro nervu bloku vai opioīdu lietošanu saistītas blakusparādības. 90% jeb 27 no 30 pacienti bija apmierināti ar pielietoto analgēziju un tiem bija laba miega kvalitāte.
Secinājumi. Pētījuma dati liecina, ka sāpju intensitātes samazināšanai vienlīdz labi darbojas gan PENG, gan Fascia iliaca bloks. Toties, pēc PENG bloka lietošanas, ievērojami samazinās nepieciešamība pēc opioīdiem, kas varētu liecināt, ka šis bloks tomēr ir efektīvāks. Lielākā daļa pacientu bija apmierināti ar pielietoto analgēziju un tiem bija laba miega kvalitāte.
Introduction. Femoral neck fractures are a common trauma in elderly people, especially women, which are mostly treated surgically. This injury is associated with severe pain, particularly in motion, and it is therefore necessary to ensure adequate analgesia both before and after surgery. Since narcotic analgesics and NSAIDs have many side effects, it is recommended to use additional analgesia methods that include regional anesthesia blocks. Aim of the research. Clarify effects of PENG and Fascia iliaca blocks on the pain intensity of the early postoperative period and find out whether opioid requirements are reduced following the use of peripheral nerve blocks. Materials and methods. A prospective observation study was conducted, which collected and analyzed data in 30 patients with a femoral neck fracture undergoing total hip replacement. The patients included in the study were divided into two groups — those, who will receive PENG blockade, and those, who will receive Fascia iliaca blockade. Data were collected on the patient's pain intensity at rest and in motion using the VAS pain scale prior to surgery, on the day of surgery and on the first postoperative day, post-surgery morphine consumption, presence of side effects, sleep quality and satisfaction with applied analgesia. Results. Of the 30 patients in the study, 25 (83.3%) were female and five (16.7%) were male. On average, the intensity of pain at rest in both peripheral nerve blocks groups were two points lower than in motion. The pain intensity at rest before surgery and on surgery day at the Fascia iliaca block group was one point higher than in PENG block group. The pain intensity in motion on operation day at 22:00 at Fascia iliaca block group was two points higher than in PENG block group. On the first postoperative day, the pain intensity was the same for both at rest and in motion in both groups. No statistically significant difference was observed between PENG and Fascia iliaca block groups in reduction of pain intensity, satisfaction with applied analgesia and sleep quality (p > 0.05). In the Fascia iliaca block group, morphine was required for 11 patients, while only for five patients in PENG block group. No side effects associated with peripheral nerve blocks or opioid use were observed in any of the patients included in the study. 90% or 27 out of 30 patients, were satisfied with the analgesia applied and had good sleep quality. Conclusions. Data from the study show that both PENG and Fascia iliaca blocks work equally well to reduce pain intensity. However, the need for opioids is significantly reduced following administration of PENG block, which could indicate that the block is more effective. Most of the patients were satisfied with the analgesia applied and had good sleep quality.
Introduction. Femoral neck fractures are a common trauma in elderly people, especially women, which are mostly treated surgically. This injury is associated with severe pain, particularly in motion, and it is therefore necessary to ensure adequate analgesia both before and after surgery. Since narcotic analgesics and NSAIDs have many side effects, it is recommended to use additional analgesia methods that include regional anesthesia blocks. Aim of the research. Clarify effects of PENG and Fascia iliaca blocks on the pain intensity of the early postoperative period and find out whether opioid requirements are reduced following the use of peripheral nerve blocks. Materials and methods. A prospective observation study was conducted, which collected and analyzed data in 30 patients with a femoral neck fracture undergoing total hip replacement. The patients included in the study were divided into two groups — those, who will receive PENG blockade, and those, who will receive Fascia iliaca blockade. Data were collected on the patient's pain intensity at rest and in motion using the VAS pain scale prior to surgery, on the day of surgery and on the first postoperative day, post-surgery morphine consumption, presence of side effects, sleep quality and satisfaction with applied analgesia. Results. Of the 30 patients in the study, 25 (83.3%) were female and five (16.7%) were male. On average, the intensity of pain at rest in both peripheral nerve blocks groups were two points lower than in motion. The pain intensity at rest before surgery and on surgery day at the Fascia iliaca block group was one point higher than in PENG block group. The pain intensity in motion on operation day at 22:00 at Fascia iliaca block group was two points higher than in PENG block group. On the first postoperative day, the pain intensity was the same for both at rest and in motion in both groups. No statistically significant difference was observed between PENG and Fascia iliaca block groups in reduction of pain intensity, satisfaction with applied analgesia and sleep quality (p > 0.05). In the Fascia iliaca block group, morphine was required for 11 patients, while only for five patients in PENG block group. No side effects associated with peripheral nerve blocks or opioid use were observed in any of the patients included in the study. 90% or 27 out of 30 patients, were satisfied with the analgesia applied and had good sleep quality. Conclusions. Data from the study show that both PENG and Fascia iliaca blocks work equally well to reduce pain intensity. However, the need for opioids is significantly reduced following administration of PENG block, which could indicate that the block is more effective. Most of the patients were satisfied with the analgesia applied and had good sleep quality.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Augšstilba kaula kakliņa lūzums, Fascia iliaca bloks, PENG bloks, analgēzija, Femoral neck fracture, Fascia iliaca block, PENG block, analgesia