RESUMO
Introducción: La fractura de cadera es una emergencia ortopédica frecuente que asocia elevada morbimortalidad y dolor intenso. Las técnicas analgo-anestésicas locorregionales, tanto centrales como periféricas, ocupan un lugar preferente dentro del arsenal terapéutico multimodal. A los bloqueos clásicos se ha sumado recientemente el bloqueo pericapsular, o PENG (PEricapsular Nerve Group). El objetivo es evaluar en pacientes con fractura de cadera la eficacia antinociceptiva del bloqueo PENG preoperatorio, el bloqueo motor residual y el tiempo necesario para la recuperación funcional postoperatoria. Material y métodos: Estudio observacional descriptivo prospectivo en pacientes programados para artroplastia total de cadera. El bloqueo PENG se realizó previo a la cirugía. Se evaluó el dolor con escala visual numérica (EVN) antes de la realización del bloqueo, 30minutos después, en el postoperatorio inmediato y a las 24horas de la intervención, el grado de bloqueo motor según la escala de Bromage y el tiempo necesario para la deambulación asistida. Resultados: En todos los pacientes el bloqueo PENG proporcionó analgesia eficaz. Logró disminuir 3 o más puntos la EVN en todos los momentos evaluados. La diferencia media entre el dolor previo y posterior al bloqueo fue de 7,5 puntos en la EVN, lo que permitió el traslado y la colocación del paciente sin alteración hemodinámica, exacerbación del dolor, ni otras complicaciones. Conclusiones: El bloqueo PENG es una técnica analgésica regional efectiva y segura para pacientes con fractura de cadera; facilita la movilización y la colocación previa a la cirugía sin exacerbación del dolor, y favorece una temprana movilidad y rehabilitación.
Introduction: Hip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. Method and materials: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. Results: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. Conclusions: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.(AU)
Assuntos
Humanos , Masculino , Feminino , Quadril/cirurgia , Analgesia , Fraturas do Quadril , Artroplastia de Quadril , Epidemiologia Descritiva , Estudos ProspectivosRESUMO
Introduction: Hip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. Method and materials: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. Results: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. Conclusions: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.(AU)
Introducción: La fractura de cadera es una emergencia ortopédica frecuente que asocia elevada morbimortalidad y dolor intenso. Las técnicas analgo-anestésicas locorregionales, tanto centrales como periféricas, ocupan un lugar preferente dentro del arsenal terapéutico multimodal. A los bloqueos clásicos se ha sumado recientemente el bloqueo pericapsular, o PENG (PEricapsular Nerve Group). El objetivo es evaluar en pacientes con fractura de cadera la eficacia antinociceptiva del bloqueo PENG preoperatorio, el bloqueo motor residual y el tiempo necesario para la recuperación funcional postoperatoria. Material y métodos: Estudio observacional descriptivo prospectivo en pacientes programados para artroplastia total de cadera. El bloqueo PENG se realizó previo a la cirugía. Se evaluó el dolor con escala visual numérica (EVN) antes de la realización del bloqueo, 30minutos después, en el postoperatorio inmediato y a las 24horas de la intervención, el grado de bloqueo motor según la escala de Bromage y el tiempo necesario para la deambulación asistida. Resultados: En todos los pacientes el bloqueo PENG proporcionó analgesia eficaz. Logró disminuir 3 o más puntos la EVN en todos los momentos evaluados. La diferencia media entre el dolor previo y posterior al bloqueo fue de 7,5 puntos en la EVN, lo que permitió el traslado y la colocación del paciente sin alteración hemodinámica, exacerbación del dolor, ni otras complicaciones. Conclusiones: El bloqueo PENG es una técnica analgésica regional efectiva y segura para pacientes con fractura de cadera; facilita la movilización y la colocación previa a la cirugía sin exacerbación del dolor, y favorece una temprana movilidad y rehabilitación.
Assuntos
Humanos , Masculino , Feminino , Quadril/cirurgia , Analgesia , Fraturas do Quadril , Artroplastia de Quadril , Epidemiologia Descritiva , Estudos ProspectivosRESUMO
INTRODUCTION: Hip fracture is a frequent orthopedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without hemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilization and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.
Assuntos
Fraturas do Quadril , Bloqueio Nervoso , Humanos , Nervo Femoral , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/cirurgia , Analgésicos/uso terapêutico , Manejo da Dor , Fraturas do Quadril/cirurgiaRESUMO
INTRODUCTION: Hip fracture is a frequent orthopaedic emergency which associates high morbidity and mortality and intense pain. Locoregional analgo-anaesthetic techniques, both central and peripheral, occupy a preferential place in the multimodal therapeutic arsenal. Recently, a new regional blockade has emerged, the pericapsular block or PENG block (PEricapsular Nerve Group). The objective is to evaluate in patients with hip fracture, the antinociceptive efficacy of the preoperative PENG block, residual motor block and time for postoperative functional recovery. METHOD AND MATERIALS: Prospective descriptive observational study with patients going to have total hip arthroplasty. PENG block was performed before surgery. Pain was assessed with the Visual Numerical Scale (VNS) before the blockade, 30min later, in the immediate postoperative period and 24h after the intervention. Motor block according to the Bromage scale and time needed for assisted walking were also evaluated. RESULTS: PENG block provided effective analgesia in all patients, with a decrease in at least 3 points on the VNS at every step in which it was evaluated. The average difference between pain before and after the block was 7.5 points on the VNS. It allowed the transfer and placement of the patient without haemodynamic alteration, exacerbation of pain or other complications. CONCLUSIONS: PENG block is an effective and safe regional analgesic technique for patients with hip fracture. It allows mobilisation and placement before surgery without pain exacerbation, promoting early mobility and rehabilitation.