Eficacia del bloqueo de los nervios obturador y femorocutáneo para analgesia postoperatoria en cirugía de cadera

Jiménez, M.I. Segado; Gago, M. Bayón; Delgado, J. Arias; García, M.L. Casas; Hervella, F. Domínguez; Pérez, A. López; Gutiérrez, C. Izquierdo

doi:10.1016/s0034-9356(09)70474-8

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…They both found that PNBs decreased average time to these mobility outcomes (mean 33 vs. 46 hours, P < 0.001, and 23 vs. 33 hours, P < 0.002, respectively) but did not further assess time to mobility through additional multivariate analyses or include standing, ambulation, or length of stay outcomes, which were the primary outcomes in this study. 19,20 By contrast, Yamamoto et al 18 assessed mobility by time to first standing and found no difference between patients receiving PNB or intravenous acetaminophen (3.0 vs. 3.1 days, P = 0.91).…”

Section: Discussionmentioning

confidence: 99%

“…16,17 A 2020 updated Cochrane review on PNB use in the setting of adult hip fractures included only three studies and a total of 208 patients with data available on time to mobilization as a secondary outcome and concluded that PNB may improve mobilization. 18-21 Only two of these studies demonstrated decreased time to mobility associated with PNB, with one showing no difference. 18-21 Translations of the studies by Segado Jimenez et al and Kullenberg et al indicate that their primary mobility outcomes were time to sitting down in a chair or time to loading or weight-bearing on the limb next to the bed, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…18-21 Only two of these studies demonstrated decreased time to mobility associated with PNB, with one showing no difference. 18-21 Translations of the studies by Segado Jimenez et al and Kullenberg et al indicate that their primary mobility outcomes were time to sitting down in a chair or time to loading or weight-bearing on the limb next to the bed, respectively. They both found that PNBs decreased average time to these mobility outcomes (mean 33 vs. 46 hours, P < 0.001, and 23 vs. 33 hours, P < 0.002, respectively) but did not further assess time to mobility through additional multivariate analyses or include standing, ambulation, or length of stay outcomes, which were the primary outcomes in this study.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral Nerve Block Delays Mobility and Increases Length of Stay in Patients With Geriatric Hip Fracture

Morriss

Kerr

Cunningham

et al. 2023

J Am Acad Orthop Surg

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Introduction: Peripheral nerve blocks (PNB) has been increasingly used in the care of patients with geriatric hip fracture to reduce perioperative opiate use and the need for general anesthesia. However, the associated motor palsy may impair patients' ability to mobilize effectively after surgery and subsequently may increase latency to key mobility milestones postoperatively, as well as increase inpatient length of stay (LOS). The aim of this study was to investigate time-tomobility milestones and length of hospital stay between peripheral, epidural, and general anesthesia.Methods: A retrospective review identified 1,351 patients aged 65 years or older who underwent surgery for hip fracture between 2012 and 2018 at a single academic health system. Patients were excluded if baseline nonambulatory, restricted weight-bearing postoperatively, or sustained concomitant injuries precluding mobilization, with a final cohort of 1,013 patients. Time-to-event analyses for discharge and mobility milestones were assessed using univariate Kaplan-Meier and multivariate Cox proportional hazard regression analyses.Results: PNB was associated with delayed postoperative time to ambulation (P , 0.001) and time to out-of-bed (P = 0.029), along with increased LOS (P , 0.001). Epidural anesthesia was associated with less delay to first out-of-bed (P = 0.002), less delay to ambulation (P = 0.001), and overall reduced length of stay (P , 0.001).Discussion: PNB was associated with slower mobilization and longer hospitalization while epidural anesthesia was associated with quicker mobilization and shorter hospital stays. Epidural anesthesia may be a preferable anesthesia choice in patients with geriatric hip fracture when possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Peripheral Nerve Block Delays Mobility and Increases Length of Stay in Patients With Geriatric Hip Fracture

Morriss

Kerr

Cunningham

et al. 2023

J Am Acad Orthop Surg

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“…Recientes estudios proponen la realización de bloqueos anestésicos periféricos para el control del dolor inmediatamente tras el ingreso, consiguiéndose una interrupción en las vías de transmisión de estímulos nociceptivos. Este tipo de anestesias regionales han demostrado una reducción significativa de la percepción de dolor postoperatorio, de la estancia hospitalaria y de los efectos adversos relacionados con fármacos (41), con una movilización más temprana y mayor grado de satisfacción de los pacientes (42).…”

Section: Introductionunclassified

Hip fracture: A 21st century socio-sanitary epidemic in the first world

Marco¹,

Galán-Olleros²,

Mora-Fernández³

2019

an. ranm

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“…Se trata de un bloqueo regional que brinda analgesia en la cadera, principalmente en la zona con más porcentaje de inervación sensitiva que corresponde a la cápsula anterior de la articulación [6]. En este bloqueo se ven involucrados el nervio obturador, el obturador accesorio y las ramas proximales del nervio femoral, encargados de la inervación sensitiva en este nivel, con escaso compromiso de la inervación motora, siendo de esta manera el bloqueo PENG aparentemente una mejor opción que los bloqueos tradicionalmente usados para analgesia de cadera como son el bloqueo 3 en 1, el bloqueo del nervio femoral y el bloqueo de la fascia iliaca, ya que estos últimos no llegan a bloquear el nervio obturador [7], [8], [9], el cual es de gran importante en la inervación de la cadera, en contraste como única desventaja en cuanto a la analgesia del bloqueo PENG, este no llega a bloquear el nervio femorocutáneo lateral (NFCL), el cual es imprescindible abarcar para brindar analgesia en la región cutánea lateral del muslo, zona donde se hacen la mayoría de las incisiones para abordaje quirúrgico de las cirugías de cadera [5].…”

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Efecto analgésico del bloqueo peng (grupo de nervios pericapsulares) en pacientes con fractura de cadera

Molinelli¹,

Romero²,

Uranga³

et al. 2020

Rev. chil. anest.

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Ultrasound regional blockade emerged that blocks the branches of the femoral nerve, obturator and accessory obturator that innervate the anterior hip capsule, the PENG block (group of pericapsular nerves), which by its Recent description does not have enough evidence in medical practice. Objectives: To verify the analgesic effect of the PENG block in patients with hip fracture and its analgesic permanence during the first 10 hours after the block in patients admitted with a diagnosis of hip fracture, at the General Interzonal Hospital of Acute "Dr Oscar E Alende "From Mar del Plata, Argentina, in the months of May to November 2019. materials and methods: A prospective descriptive observational study was carried out with a total of 53 patients, hospitalized patients with a diagnosis of hip fracture, with standardized intravenous analgesic scheme and who have not yet undergone hip surgery. Pain was evaluated with the EVA scale (visual analog scale) prior to the blockage, and then at 30 min and 10 hours after the blockade, 15 ml of 1% lidocaine and 15 ml of bupivacaine at 0 were used. 25%, convex or linear ultrasound probe according to patient weight and 100 mm needle. In order to reproduce and evaluate the pain, the patients had a 30º flexion of the hip. results: Prior to the blockade, 66% of the patients had severe pain and 34% moderate pain, none presented mild pain or absence, both at thirty minutes and ten hours after the blockade, no patient presented severe pain and all patients presented analgesia with a decrease in more than three points on the VAS scale, in some cases reaching a decrease of 10 points on that scale. Conclusions: The PENG block is a regional anesthesia technique that provides very good analgesia to patients with hip fractures, therefore, it is an excellent saving strategy for systemic analgesics. Knowing the analgesia provided by the blockade at 30 min and at 10 h, it could

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Eficacia del bloqueo de los nervios obturador y femorocutáneo para analgesia postoperatoria en cirugía de cadera

Cited by 11 publications

References 18 publications

Peripheral Nerve Block Delays Mobility and Increases Length of Stay in Patients With Geriatric Hip Fracture

Peripheral Nerve Block Delays Mobility and Increases Length of Stay in Patients With Geriatric Hip Fracture

Hip fracture: A 21st century socio-sanitary epidemic in the first world

Efecto analgésico del bloqueo peng (grupo de nervios pericapsulares) en pacientes con fractura de cadera

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