Pericapsular nerve group block in combination with the supine coronal approach to anterior quadratus
lumborum block for hip fracture surgery in elderly patients
XU Xian’gen1, 2, WANG Haidan1, LIN Xiangyang1, LI Chenchen1, HUANG Bingwu2, LI Ting2
1.Department of Anesthesiology, Cangnan AffiliatedHospital of Wenzhou Medical University, Wenzhou 325800, China; 2.Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
XU Xian’gen,WANG Haidan,LIN Xiangyang, et al. Pericapsular nerve group block in combination with the supine coronal approach to anterior quadratus
lumborum block for hip fracture surgery in elderly patients[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(10): 828-832，838.
Abstract：Objective: To evaluate the perioperative analgesic effect of pericapsular nerve group (PENG) block in combination with the supine coronal approach to anterior quadratus lumborum block (SCAQLB) for hip
fracture surgery in elderly patients. Methods: A total of 80 elderly patients undergoing hip fracture surgery in Cangnan Hospital Affiliated to Wenzhou Medical University from January 2023 to December 2023 were selected,who were randomly divided into 2 groups (n=40 each) using a random number table: PENG in combination withSCAQLB (group PS) and fascia iliaca compartment block (FICB) group (group F). All patients underwent nerve block for analgesia guided under ultrasound before changes of position for combined spinal-epidural anesthesia.The cumulative consumption of sufentanil and the time to first compression within 24 hours after surgery through patient-controlled intravenous analgesia (PCIA) were recorded. The visual analogue scale (VAS) scores at rest and during movement were recorded when patients entering the operation room (T0), 30 min after nerve block (T1),6 h (T2), 12 h (T3) and 24 h (T4) after surgery. Ease of spinal anesthesia positioning, rate of rescue analgesia at the time of the position changing, patient’s satisfaction score and complications such as quadriceps weakness were also recorded. Results: The cumulative consumption of sufentanil in group PS was lower than that in group F (P<0.001). Time to first PCIA request was prolonged significantly in group PS than that in group F (P<0.001).VAS scores at rest and during movement in group PS were lower than those in group F at T1 to T4 (P<0.05).The satisfaction rate of patients was significantly higher in group PS than in group F (P<0.05). The rate of rescue analgesia at the time of the position changing was lower in group PS than in group F (P<0.05). The satisfaction rate of anesthesiologists with body position in group PS was higher than in group F (P<0.05). No case of quadriceps weakness occurred in group PS, whereas 9 cases occurred in group F. Conclusion: PENG in combination with SCAQLB is superior to FICB in that it can provide good analgesic effect on the positioning pain before spinal anesthesia and postoperative pain in elderly patients undergoing hip fracture surgery, without weakening the quadriceps muscle strength but improving patient’s satisfaction.
