Đánh giá bước đầu hiệu quả giảm đau của gây tê mặt phẳng cơ dựng sống vùng cùng cụt cho phẫu thuật thay khớp háng

Postoperative pain management is crucial for patients undergoing hip arthroplasty, a highly effective procedure for end-stage hip diseases. Inadequate pain control can lead to severe complications and hinder early recovery, especially in elderly patients. Traditional regional anesthesia techniques often present limitations, such as incomplete analgesic coverage (e.g., leaving posterior hip pain unaddressed) or potential motor weakness, which can impede patient mobilization. The sacral erector spinae plane block (S-ESPB) has emerged as a promising novel regional anesthetic technique, offering comprehensive pain relief by blocking sacral nerves without significantly affecting motor function. This study aims to provide an initial evaluation of the analgesic efficacy and safety of continuous S-ESPB for patients undergoing hip arthroplasty, contributing to the growing evidence for enhanced recovery after surgery.

Anesthesiologists, orthopedic surgeons, pain management specialists, and researchers interested in regional anesthesia and enhanced recovery after hip arthroplasty.

This prospective, descriptive study investigated the initial analgesic efficacy and safety of continuous sacral erector spinae plane block (S-ESPB) in 25 ASA I-III patients undergoing elective hip arthroplasty at Bachmai Hospital. Patients received a continuous ultrasound-guided unilateral S-ESPB with a catheter for postoperative pain management, complemented by a multimodal regimen involving paracetamol and diclofenac. Key outcomes assessed included total rescue Morphine consumption over 72 hours, visual analog scale (VAS) scores at rest and with movement at specified intervals, adverse events, and patient satisfaction. The study found that the mean duration for performing the S-ESPB was 18.05 ± 4.85 minutes. Postoperative VAS scores remained consistently low (below 4 at rest and approximately 5 with movement) throughout the 72-hour study period. Morphine consumption was significantly reduced, with mean values of 3.04 ± 3.46 mg during 0-24 hours and 1.08 ± 2.04 mg during 24-48 hours; notably, 40% of patients required no supplemental Morphine. The incidence of adverse events was low, with 8% each for pain at the catheter site and nausea/vomiting, and no serious complications like hypotension or nerve injury were observed. A high patient satisfaction rate of 92% was reported. These findings suggest that continuous S-ESPB effectively contributes to reduced postoperative pain and lower Morphine consumption during the first three days post-hip replacement surgery, promoting enhanced recovery pathways. While promising, the study acknowledges limitations, including its non-comparative design and the need for further randomized controlled trials to confirm its superiority over other regional anesthesia techniques.