PROSPECTIVE RANDOMIZED STUDY COMPARING SUPRAINGUINAL FASCIA ILIACA BLOCK VERSUS PERICAPSULAR NERVE GROUP BLOCK VERSUS LOCAL ANAESTHETIC INFILTRATION VERSUS SPINAL ANAESTHETIC WITHOUT ADJUNCTS FOR PAIN CONTROL FOLLOWING TOTAL HIP ARTHROPLASTY
Notice bibliographique
Résumé
Postoperative pain following total hip arthroplasty (THA) leads to increased narcotic consumption, decreased patient satisfaction, delayed mobilization, and prolonged hospital stays.1 Multimodal analgesia has become the standard of care following THA, and can include various regional anesthetic adjuncts such as suprainguinal fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block, as well as local anesthetic infiltration (LAI) by the surgeon.2 The most efficacious regional anesthetic adjunct is yet to be determined, with inconsistent evidence on their efficacy and no randomized study directly comparing these three adjuncts to date.3-6 The purpose of this randomized trial was to compare the impact of FICB, PENG block, and LAI on postoperative pain, opioid use, and side effects associated with pain control following primary THA for osteoarthritis. One hundred and thirty-nine patients undergoing primary THA under spinal anesthesia for hip osteoarthritis were randomized to receive FICB (n=35), PENG block (n=35), LAI (n=33), or spinal anesthetic without any adjuncts (control; n=36). The primary outcome was cumulative opioid consumption at 24 hours postoperatively. Cumulative opioid consumption (in mg of morphine-equivalents) was recorded at four, 24, and 48 hours postoperatively. Postoperative pain scores (visual analog pain scale; VAS) were recorded at four hours, immediately before and after the first physiotherapy session, and at two and four days. Finally, patient satisfaction with pain control, length of hospital stay and complications were also recorded. For statistical analysis, group comparisons were performed using two-tailed t-test (alpha = 0.05). All study groups had similar patient demographics, including mean age, gender, BMI. At 24 hours postoperatively, all groups with adjuncts had significantly lower cumulative opioid consumption (FICB = 27.0 mg, LAI = 26.9 mg, PENG = 30.3 mg) compared to the control group (42.7 mg; p=0.003, p=0.004, p=0.016, respectively). FICB group had lower opioid consumption at four hours postoperatively compared to the control group (2.4 mg vs. 5.9 mg; p < 0 .05) while LAI group and PENG block group had similar opioid consumption to the control group. In addition, LAI group had lower pain at 4 hours (VAS = 1.8) compared to the control group (VAS = 3.1; p=0.026). While there was no statistically significant difference in patient satisfaction with postoperative pain management across the study groups, there was a trend toward improved satisfaction for LAI (effect size 0.65, p=0.08). FICB, LAI and PENG block are equally efficacious in reducing opioid consumption for acute postoperative pain, when compared to spinal anesthesia alone. Of note, patients who received LAI had decreased subjective pain at 4 hours and a trend towards better satisfaction with pain control following THA. Because LAI can be performed intra-operatively, without the need for a secondary procedure, this may be the adjunct of choice to improve pain control post-THA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,006 | 0,004 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».