medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-6-57-61medalphabet-3105Research ArticleСтатьиЭффективность блокады подвздошной фасции при тотальном эндопротезировании тазобедренного суставаEfficiency of fascia iliaca block in total hip arthroplastyhttps://orcid.org/0000-0001-7755-7163КрыловС. В.KrylovS. V.

Крылов Сергей Валерьевич, к.м.н., зав. отделением анестезиологии –  реанимации № 2; доцент кафедры анестезиологии и реаниматологии

Москва

Krylov Sergey V., PhD Med, head of Dept of Anesthesiology and Intensive Care No. 21, associate professor at Dept of Anesthesiology and Resuscitation

Moscow

doc087@inbox.ruhttps://orcid.org/0000-0002-8121-4160ПасечникИ. Н.PasechnikI. N.

Пасечник Игорь Николаевич, д.м.н., проф., гл. внештатный специалист по анестезиологии-реаниматологии Главного медицинского управления Управления делами Президента России, зав. кафедрой анестезиологии и реаниматологии

Москва

Pasechnik Igor N., DM Sci (habil.), professor, chief freelance specialist in anesthesiology and resuscitation of the Main Medical Directorate of the Presidential Administration of the Russian Federation, head of Dept of Anesthesiology and Resuscitation

Moscow

pasigor@yandex.ruГужевС. С.GuzhevS. S.

Гужев Сергей Сергеевич, врач – анестезиолог-реаниматолог отделения анестезиологии – реанимации № 2; ассистент кафедры анестезиологии и реаниматологии

Москва

Guzhev Sergey S., anesthesiologist-resuscitator at Dept of Anesthesiology and Intensive Care No. 2, assistant at Dept of Anesthesiology and Resuscitation

Moscow

feldsher03@mail.ruОрлецкийА. К.OrletskiyA. K.

Орлецкий Анатолий Корнеевич, д.м.н., проф., лауреат премии правительства России в области науки, заслуженный врач РФ, зав. отделением спортивной травмы № 4

Москва

Orletsky Anatoly K., DM Sci (habil.), professor, laureate of the Prize of the Government of Russia in the field of science, honored doctor of the Russian Federation, head of Sports Injury Dept No. 4

Moscow

sport.cito@gmail.comШумскийА. А.ShumskiyA. A.

Шумский Алексей Андреевич, к.м.н., врач – травматолог-ортопед отделения спортивной травмы № 4

Москва

Shumsky Aleksey A., PhD Med, traumatologist-orthopedist at Sports Injury Dept No. 4

Moscow

alexszumski@gmail.comДгебуадзеГ.DgebuadzeG.

Дгебуадзе Георгий, врач – травматолог-ортопед отделения спортивной травмы № 4

Москва

Dgebuadze Georgy, traumatologist-orthopedist at Sports Injury Dept No. 4

Moscow

mr.dgebuadze777@mail.ruГерасенковаА. Д.GerasenkovaA. D.

Герасенкова Анастасия Дмитриевна, врач – травматолог-ортопед, аспирант

Москва

Gerasenkova Anastasia D., traumatologist-orthopedist, postgraduate student

Moscow

nastennmodelmay@mail.ruФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Минздрава России; ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияNational Medical Research Center for Traumatology and Orthopedics n. a. N. N. PriorovRussian FederationФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияCentral State Medical AcademyRussian FederationФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Минздрава России; ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияNational Medical Research Center for Traumatology and Orthopedics n. a. N. N. Priorov; Central State Medical AcademyRussian FederationФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Минздрава РоссииРоссияNational Medical Research Center for Traumatology and Orthopedics n. a. N. N. PriorovRussian Federation20230806202306Кардиология. Неотложная медицина» (1)5761Copyright © Крылов С.В., Пасечник И.Н., Гужев С.С., Орлецкий А.К., Шумский А.А., Дгебуадзе Г., Герасенкова А.Д., 20232023Крылов С.В., Пасечник И.Н., Гужев С.С., Орлецкий А.К., Шумский А.А., Дгебуадзе Г., Герасенкова А.Д.Krylov S.V., Pasechnik I.N., Guzhev S.S., Orletskiy A.K., Shumskiy A.A., Dgebuadze G., Gerasenkova A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3105Введение

Введение. В представленном исследовании изучили влияние блокады подвздошной фасции у пациентов после первичного тотального эндопротезирования тазобедренного сустава (ТЭТС).

Цель работы

Цель работы. Оценка эффективности ибезопасности использования блокады подвздошной фасции в послеоперационном периоде после ТЭТС.

Материалы и методы

Материалы и методы. В исследование включили 60 пациентов, которым выполнили первичное ТЭТС. Пациенты были разделены случайным образом на две группы: группа 1 (n = 30) – пациенты, которым в послеоперационном периоде проводили мультимодальную схему послеоперационной анальгезии; группа 2 (n = 30) – пациенты, которым, кроме мультимодальной анальгезии, выполняли блокаду подвздошной фасции бедра под ультразвуковой навигацией после операции. В послеоперационном периоде регистрировали уровень болевого синдрома в покое и при движении, используя визуально-аналоговую шкалу уровня боли (ВАШ1 и ВАШ2) через 6–12–24–48 часов. Также регистрировали кратность и количество назначения наркотических анальгетиков и отмечали частоту развития побочных эффектов от их использования.

Результаты

Результаты. Показатели уровня болевого синдрома в покое и при движении в первые 24 часа были ниже у пациентов второй группы. Через 48 часов достоверных различий между группами по уровню боли не обнаружено. Пациентам первой группы чаще назначались опиоидные анальгетики, чем пациентам второй. Количество побочных эффектов от использования наркотических анальгетиков было больше у пациентов первой группы.

Выводы

Выводы. Использование блокады подвздошной фасции является эффективным методом периоперационной анальгезии после эндопротезирования тазобедренного сустава. Данный метод позволяет достигать высокий уровень обезболивания и снижает потребность в назначении опиоидных анальгетиков.

Introduction

Introduction. The present study examined the effect of iliac fascia blockade in patients after primary total hip arthroplasty (TEH).

Purpose

Purpose. Evaluation of the efficacy and safety of using the iliac fascia blockade in the postoperative period after TEH.

Materials and methods

Materials and methods. The study included 60 patients who underwent primary TEH. Patients were randomly divided into two groups: group 1 (n = 30) – patients who underwent a multimodal scheme of postoperative analgesia in the postoperative period; group 2 (n = 30) – patients who, in addition to multimodal analgesia, underwent blockade of the iliac fascia of the thigh under ultrasound navigation after surgery. In the postoperative period, the level of pain syndrome at rest and during movement was recorded using a visual analog scale of the pain level (VAS 1 and VAS 2) after 6–12–24–48 hours. We also recorded the frequency and quantity of prescription of narcotic analgesics and noted the frequency of side effects from their use.

Results

Results. The level of pain syndrome at rest and during movement in the first 24 hours was lower in patients of the 2nd group. After 48 hours, there were no significant differences between the groups in the level of pain. Patients in group 1 were prescribed opioid analgesics more often than patients in group 2. The number of side effects from the use of narcotic analgesics was greater in patients of group 1.

Conclusions

Conclusions. The use of the iliac fascia block is an effective method of perioperative analgesia after hip arthroplasty. This method allows achieving a high level of pain relief and reduces the need for prescription of opioid analgesics.

регионарная анестезияблокада периферических нервовблокада подвздошной фасцииэндопротезирование тазобедренного суставаregional anesthesiaperipheral nerve blockiliac fascia blockhip arthroplastyReferencesLearmonth I.D., Young C., Rorabeck C. The operation of the century: Total hip replacement. Lancet. 2007; 370: 1508–1519. DOI: 10.1016/S0140–6736(07)60457–7.Learmonth I.D., Young C., Rorabeck C. The operation of the century: Total hip replacement. Lancet. 2007; 370: 1508–1519. DOI: 10.1016/S0140–6736(07)60457–7.National Institutes of Health NIH consensus conference: Total hip replacement. NIH consensus development panel on total hip replacement. JAMA. 1995; 273: 1950–1956. DOI: 10.1001/jama.273.24.1950.National Institutes of Health NIH consensus conference: Total hip replacement. NIH consensus development panel on total hip replacement. JAMA. 1995; 273: 1950–1956. DOI: 10.1001/jama.273.24.1950.Kane R. L., Saleh K. J., Wilt T. J., Bershadsky B., Cross W. W., MacDonald R.M., Rutks I. Total knee replacement. Evid. Rep. Technol. Assess. 2003; 86: 1–8.Kane R. L., Saleh K. J., Wilt T. J., Bershadsky B., Cross W. W., MacDonald R.M., Rutks I. Total knee replacement. Evid. Rep. Technol. Assess. 2003; 86: 1–8.Laupacis A., Bourne R., Rorabeck C., Feeny D., Wong C., Tugwell P., Leslie K., Bullas R. The effect of elective total hip replacement on health-related quality of life. J. Bone Jt. Surg. 1993; 75: 1619–1626. DOI: 10.2106/00004623–199311000–00006.Laupacis A., Bourne R., Rorabeck C., Feeny D., Wong C., Tugwell P., Leslie K., Bullas R. The effect of elective total hip replacement on health-related quality of life. J. Bone Jt. Surg. 1993; 75: 1619–1626. DOI: 10.2106/00004623–199311000–00006.Felson D. T. The epidemiology of knee osteoarthritis: Results from the Framingham Osteoarthritis Study. Semin. Arthritis Rheum. 1990; 20: 42–50. DOI: 10.1016/0049– 0172(90)90046-I.Felson D. T. The epidemiology of knee osteoarthritis: Results from the Framingham Osteoarthritis Study. Semin. Arthritis Rheum. 1990; 20: 42–50. DOI: 10.1016/0049– 0172(90)90046-I.Mamlin L.A., Melfi C.A., Parchman M. L., Michael L., Benjamin G., Deborah I., Barry P.K., Robert S.D., David A.H., Deborah A., et al. Management of osteoarthritis of the knee by primary care physicians. Arch. Fam. Med. 1998; 7: 563–567. DOI: 10.1001/archfami.7.6.563.Mamlin L.A., Melfi C.A., Parchman M. L., Michael L., Benjamin G., Deborah I., Barry P.K., Robert S.D., David A.H., Deborah A., et al. Management of osteoarthritis of the knee by primary care physicians. Arch. Fam. Med. 1998; 7: 563–567. DOI: 10.1001/archfami.7.6.563.Kopp S. L., Børglum J., Buvanendran A. More anesthesia and analgesia practice pathway options for total knee arthroplasty: An evidence-based review by the American and European societies of regional anesthesia and pain medicine. Reg. Anesth. Pain Med. 2017; 42: 683–697. DOI: 10.1097/AAP.0000000000000673.Kopp S. L., Børglum J., Buvanendran A. More anesthesia and analgesia practice pathway options for total knee arthroplasty: An evidence-based review by the American and European societies of regional anesthesia and pain medicine. Reg. Anesth. Pain Med. 2017; 42: 683–697. DOI: 10.1097/AAP.0000000000000673.Memtsoudis S. G., Sun X., Chiu Y. L., Stundner O., Spencer S. L., Banerjee S., Mazumdar M., Nigel E. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013; 118: 1046–1058. DOI: 10.1097/ALN.0b013e318286061d.Memtsoudis S. G., Sun X., Chiu Y. L., Stundner O., Spencer S. L., Banerjee S., Mazumdar M., Nigel E. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013; 118: 1046–1058. DOI: 10.1097/ALN.0b013e318286061d.Misiołek H., Zajączkowska R., Daszkiewicz A., Woroń J., Dobrogowski J., Wordliczek J., Owczuk R. Postoperative pain management – 2018 consensus statement of the section of regional anaesthesia and pain therapy of the polish society of anaesthesiology and intensive therapy, the polish society of regional anaesthesia and pain therapy, the polish association for the study of pain and the national consultant in anaesthesiology and intensive therapy. Anaesthesiol. Intensive Ther. 2018; 50: 173–179.Misiołek H., Zajączkowska R., Daszkiewicz A., Woroń J., Dobrogowski J., Wordliczek J., Owczuk R. Postoperative pain management – 2018 consensus statement of the section of regional anaesthesia and pain therapy of the polish society of anaesthesiology and intensive therapy, the polish society of regional anaesthesia and pain therapy, the polish association for the study of pain and the national consultant in anaesthesiology and intensive therapy. Anaesthesiol. Intensive Ther. 2018; 50: 173–179.Opperer M., Danninger T., Stundner O., Memtsoudis S.G. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence-based review. World J. Orthop. 2014; 5: 336–343. DOI: 10.5312/wjo.v5.i3.336.Opperer M., Danninger T., Stundner O., Memtsoudis S.G. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence-based review. World J. Orthop. 2014; 5: 336–343. DOI: 10.5312/wjo.v5.i3.336.Husted H., Hansen H.C., Holm G., Bach-Dal C., Rud K., Lande Andersen K., Kehlet H. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch. Orthop. Trauma Surg. 2010; 130: 263–268. DOI: 10.1007/s00402–009–0940–7.Husted H., Hansen H.C., Holm G., Bach-Dal C., Rud K., Lande Andersen K., Kehlet H. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch. Orthop. Trauma Surg. 2010; 130: 263–268. DOI: 10.1007/s00402–009–0940–7.Kerr D.R., Kohan L. Local infiltration analgesia: A technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthop. 2008; 79: 174–183. DOI: 10.1080/17453670710014950.Kerr D.R., Kohan L. Local infiltration analgesia: A technique for the control of acute postoperative pain following knee and hip surgery: A case study of 325 patients. Acta Orthop. 2008; 79: 174–183. DOI: 10.1080/17453670710014950.Steenberg J., Moller A.M. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br. J. Anaesth. 2018; 120: 1368–1380. DOI: 10.1016/j.bja.2017.12.042.Steenberg J., Moller A.M. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br. J. Anaesth. 2018; 120: 1368–1380. DOI: 10.1016/j.bja.2017.12.042.Vaughan B., Manley M., Stewart D., Iyer V. Distal injection site may explain lack of analgesia from fascia iliaca block for total hip. Reg. Anesth. Pain Med. 2013; 38: 556–557. DOI: 10.1097/AAP.0000000000000011.Vaughan B., Manley M., Stewart D., Iyer V. Distal injection site may explain lack of analgesia from fascia iliaca block for total hip. Reg. Anesth. Pain Med. 2013; 38: 556–557. DOI: 10.1097/AAP.0000000000000011.Hebbard P., Ivanusic J., Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: A cadaveric evaluation of a novel approach. Anaesthesia. 2011; 66: 300–305. DOI: 10.1111/j.1365–2044.2011.06628.x.Hebbard P., Ivanusic J., Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: A cadaveric evaluation of a novel approach. Anaesthesia. 2011; 66: 300–305. DOI: 10.1111/j.1365–2044.2011.06628.x.Swenson J.D., Davis J. J., Stream J.O., Crim J.R., Burks R. T., Greis P.E. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: The pattern of distribution and effects on the obturator nerve. J. Clin. Anesth. 2015; 27: 62–67. DOI: 10.1016/j.jclinane.2015.07.001.Swenson J.D., Davis J. J., Stream J.O., Crim J.R., Burks R. T., Greis P.E. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: The pattern of distribution and effects on the obturator nerve. J. Clin. Anesth. 2015; 27: 62–67. DOI: 10.1016/j.jclinane.2015.07.001.Liu S. S., Buvanendran A., Rathmell J. P., Sawhney M., James J. B., Moric M., Stephen P., Ashley J.P., Lazaros P., Craig J.D.V., et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int. Orthop. 2012; 36: 2261–2267. DOI: 10.1007/s00264–012–1623–5.Liu S. S., Buvanendran A., Rathmell J. P., Sawhney M., James J. B., Moric M., Stephen P., Ashley J.P., Lazaros P., Craig J.D.V., et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int. Orthop. 2012; 36: 2261–2267. DOI: 10.1007/s00264–012–1623–5.Hong H.K., Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: A meta-analysis. Medicine. 2019; 98: e16157. DOI: 10.1097/ MD.0000000000016157.Hong H.K., Ma Y. The efficacy of fascia iliaca compartment block for pain control after hip fracture: A meta-analysis. Medicine. 2019; 98: e16157. DOI: 10.1097/ MD.0000000000016157.Haines L., Dickman E., Ayvazyan S., Pearl M., Wu S., Rosenblum D., Likourezos A. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J. Emerg. Med. 2012; 43: 692–697. DOI: 10.1016/j. jemermed.2012.01.050.Haines L., Dickman E., Ayvazyan S., Pearl M., Wu S., Rosenblum D., Likourezos A. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J. Emerg. Med. 2012; 43: 692–697. DOI: 10.1016/j. jemermed.2012.01.050.Desmet M., Vermeylen K., Van Herreweghe I., Carlier L., Soetens F., Lambrecht S., Croes K., Pottel H., Van de Velde M. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth. Pain Med. 2017; 42: 327–333. DOI: 10.1097/AAP.0000000000000543.Desmet M., Vermeylen K., Van Herreweghe I., Carlier L., Soetens F., Lambrecht S., Croes K., Pottel H., Van de Velde M. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth. Pain Med. 2017; 42: 327–333. DOI: 10.1097/AAP.0000000000000543.Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.Bohringer C., Astorga C., Liu H. The benefits of opioid free anesthesia and the precautions necessary when employing it. Transl. Perioper. Pain Med. 2020; 7: 152–157.Bohringer C., Astorga C., Liu H. The benefits of opioid free anesthesia and the precautions necessary when employing it. Transl. Perioper. Pain Med. 2020; 7: 152–157.Ayoo K., Mikhaeil J., Huang A., Wąsowicz M. The opioid crisis in North America: Facts and future lessons for Europe. Anaesthesiol Intensive Ther. 2020; 52: 139–147. DOI: 10.5114/ait.2020.94756.Ayoo K., Mikhaeil J., Huang A., Wąsowicz M. The opioid crisis in North America: Facts and future lessons for Europe. Anaesthesiol Intensive Ther. 2020; 52: 139–147. DOI: 10.5114/ait.2020.94756.Gao Y., Tan H., Sun R., Zhu J. Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty: A systematic review and meta-analysis. Int. J. Surg. 2019; 65: 70–79. DOI: 10.1016/j.ijsu.2019.03.014.Gao Y., Tan H., Sun R., Zhu J. Fascia iliaca compartment block reduces pain and opioid consumption after total hip arthroplasty: A systematic review and meta-analysis. Int. J. Surg. 2019; 65: 70–79. DOI: 10.1016/j.ijsu.2019.03.014.Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.Zhang X.Y., Ma J.B. The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: A meta-analysis. J. Orthop. Surg. Res. 2019; 66: 89–98. DOI: 10.1186/s13018–018–1053–1.

The authors declare that there are no conflicts of interest present.