Hip fractures are a common and serious issue among older adults worldwide, with an aging population increasing the prevalence of this condition. This problem not only affects the quality of life for patients but also places a significant burden on families and society due to the associated high morbidity and mortality rates.
In 2018, a new technique called the Pericapsular Nerve Group (PENG) block was introduced, targeting specific nerves around the hip joint to provide effective pain relief. While nerve blocks can reduce pain during the early postoperative period, a phenomenon known as "rebound pain" can occur, causing physical and mental distress and potentially undermining the benefits of nerve blocks. Rebound pain is defined as a significant increase in pain intensity after the nerve block wears off, often within 24 hours.
To address this issue, researchers have been exploring the use of ultra-long-acting local anesthetics, specifically liposomal bupivacaine (LB), to prevent rebound pain. LB is a novel, long-acting anesthetic agent that utilizes a unique technology to encapsulate bupivacaine, allowing for a slow and sustained release of the drug.
This study aimed to investigate the impact of LB on rebound pain following PENG block in elderly Chinese patients with hip fractures. The research was conducted at Anhui Medical University's Fourth Affiliated Hospital and approved by the hospital's Ethics Committee.
The study enrolled patients undergoing elective hip arthroplasty, with a focus on those aged 65 and above. Patients were randomly assigned to three groups: the LB group (receiving liposomal bupivacaine), the R group (active control, receiving ropivacaine), and the C group (negative control). The primary outcome measures included pain scores (NRS) at different time points postoperatively and the incidence of rebound pain. Secondary outcomes assessed mean arterial pressure and heart rate, pain scores during exercise, the number of analgesic pump presses, and the incidence of adverse events.
The results showed that the LB group had significantly lower pain scores at 12, 24, and 48 hours postoperatively compared to the R and C groups. The incidence of rebound pain was also lower in the LB group, suggesting that LB can effectively reduce rebound pain in hip fracture patients.
Furthermore, the LB group demonstrated fewer analgesic pump presses and a lower incidence of dizziness and vomiting compared to the C group. This indicates that LB not only provides better pain control but also reduces the need for additional analgesics and associated side effects.
However, the study also found that the larger volume of LB used (30 mL) may have a potential impact on postoperative muscle strength, as a subset of patients in the LB group experienced decreased muscle strength within 12 hours postoperatively.
In conclusion, this study highlights the potential of liposomal bupivacaine in reducing rebound pain and accelerating postoperative recovery in hip fracture patients. While further research with larger sample sizes is needed to validate these findings, the results suggest that LB-based PENG block could be a valuable addition to the management of hip fractures, offering improved pain control and reduced opioid use without compromising muscle function.
