Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial
Comparação entre o bloqueio do grupo de nervos pericapsulares e o bloqueio quadrado lombar anterior para cirurgia de fratura de quadril: ensaio clínico randomizado
Mustafa Aslan, Alper Kilicaslan, Funda Gök, Ahmet Fevzi Kekec, Tahsin Sami Colak
Abstract
Background
Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.
Methods
Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2 −10 cm H2O) via a nasal mask (Group A) or constant CPAP (7.5 cm H2O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO2, PaO₂/FiO₂, SpO2) and spirometry (FVC, FEV1, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0−10, with 0 indicating the best comfort) and complications were recorded.
Results
PaO2/FiO2 improvement was lower in Group A (32.6 § 26.3 mmHg) than in Group C (52.9 § 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% § 4.0%) than in Group C (6.7% § 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2−3] vs. 3 [2−4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery
Conclusion
Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.
Keywords
Resumo
Introdução
Este estudo comparou o bloqueio do Grupo de Nervos Pericapsulares (PENG) combinado com o bloqueio do Nervo Cutâneo Femoral Lateral (LFCN) ao bloqueio anterior do Bloqueio do Quadrado Lombar (QLB) em pacientes submetidos à Artroplastia Total de Quadril (THA).
Métodos
Neste ensaio prospectivo, duplo-cego, 80 adultos programados para THA sob anestesia raquidiana foram randomizados para receber bloqueio anterior de QLB (n = 40) com 30 mL de bupivacaína 0,25% ou bloqueio combinado PENG + LFCN (n = 40) utilizando 25 mL de bupivacaína 0,25% para PENG e 5 mL para LFCN. O desfecho primário foi o consumo acumulado de morfina intravenosa nas primeiras 24 horas pós-operatórias. Desfechos secundários incluíram escores de dor, força do quadríceps, satisfação do paciente e efeitos colaterais.
Resultados
Não foram observadas diferenças significativas entre os grupos no consumo de morfina ou escores de dor durante as primeiras 12 horas (p > 0,05). Com 24 horas, o grupo PENG + LFCN apresentou consumo significativamente menor de morfina (p = 0,027) e escores de VAS em repouso mais baixos (p < 0,001). Fraqueza do quadríceps ocorreu em 15% (6/40) dos pacientes do bloqueio anterior de QLB às 6 horas (p = 0,026), enquanto nenhum caso de fraqueza foi observado no grupo PENG + LFCN nas 24 horas avaliadas. A satisfação dos pacientes e a incidência de complicações foram comparáveis entre os grupos.
Conclusão
Tanto o bloqueio anterior de QLB quanto o bloqueio combinado PENG + LFCN proporcionam analgesia eficaz por até 12 horas após a THA. Entretanto, a combinação PENG + LFCN oferece analgesia prolongada, redução na necessidade de opioides e melhor preservação da força do quadríceps.
Palavras-chave
References
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Submitted date:
02/10/2025
Accepted date:
05/03/2025
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