Hip fractures are a common and serious issue among older adults worldwide, with an aging population leading to an increasing prevalence. This condition 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 in the early postoperative period, a phenomenon known as nerve block rebound pain can occur, causing physical and mental distress and potentially undermining the benefits of the nerve block.
To address this issue, researchers have been exploring the use of ultra-long-acting local anesthetics, specifically liposomal bupivacaine, to prevent rebound pain. Liposomal bupivacaine is a novel, long-acting anesthetic agent that utilizes advanced technology to encapsulate bupivacaine, allowing for a slow and sustained release of the drug.
This study aimed to investigate the impact of liposomal bupivacaine on rebound pain following PENG block in elderly Chinese patients with hip fractures. The study was conducted at the Fourth Affiliated Hospital of Anhui Medical University and followed rigorous ethical guidelines, including obtaining informed consent from patients or their legal representatives.
A total of 90 patients were enrolled in the study, with three groups: the liposomal bupivacaine group (LB), the ropivacaine group (R), and a negative control group (C). The primary outcome measures included pain scores (NRS) at various time points postoperatively and the area under the NRS curve (AUC). Secondary outcome measures assessed mean arterial pressure (MAP), heart rate (HR), pain scores during exercise, the number of analgesic pump presses, quadriceps muscle function, and the incidence of adverse events.
The results showed that the LB group had significantly lower NRS scores at 12, 24, and 48 hours postoperatively compared to the R and C groups. The AUC of NRS scores was also significantly lower in the LB group, indicating better pain control. Additionally, the LB group demonstrated a lower incidence of rebound pain and fewer analgesic pump presses compared to the C group.
However, there were some limitations to the study. The sample size was relatively small, and the study was conducted at a single center, which may limit the generalizability of the findings. Furthermore, the test protocol relied mostly on subjective patient ratings, which could introduce some unreliability.
Despite these limitations, the study provides valuable insights into the potential benefits of liposomal bupivacaine in reducing rebound pain and improving postoperative recovery. Further research with larger sample sizes and more objective outcome measures is warranted to confirm these findings and establish the optimal use of liposomal bupivacaine in clinical practice.
