连续腰丛神经阻滞联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价  

Efficacy of continuous lumbar plexus block combining with multimodal analgesia after revision hip arthroplasty

作　　者：熊秋菊[1] 刘小男[1] 何开华[1] 闵苏[1] Xiong Qiuju Liu Xiaonan He Kaihua Min Su(Department of Anesthesiology,The First Affiliated Hospital of Chongqing Medical Universit)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《重庆医科大学学报》2017年第5期560-564,共5页Journal of Chongqing Medical University

基　　金：国家临床重点专科建设项目经费资助项目(编号:2011-170);重庆市医学重点学科建设经费资助项目(编号:2007-2)

摘　　要：目的:比较连续腰丛神经阻滞(continuous lumbar plexus block,CLPB)联合多模式镇痛与患者静脉自控镇痛(patient controlled intravenous analgesia,PCIA)联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价。方法:68例单侧髋关节翻修的患者随机平均分成CLPB组与PCIA组。2组患者术前3 d使用帕瑞昔布钠镇痛;CLPB组术后经患侧腰丛神经周围置管处使用罗哌卡因镇痛,PCIA组术后经静脉使用曲马多加氟比洛芬酯镇痛,2组患者持续镇痛3 d,且术后加用帕瑞昔布钠镇痛直至运动时VAS评分<3分。记录患者术后在静息及运动状态下的视觉模拟疼痛评分(visual analogue scale,VAS)、静脉注射帕瑞昔布钠用量、镇痛泵按压次数及不良反应。结果:CLPB组患者术后各时刻点在静息状态及运动状态下的VAS评分明显低于PCIA组(P<0.05);CLPB组术后6、12、24 h在运动状态下的VAS评分分别为(2.50±0.71)、(3.59±0.99)、(3.67±1.01)分,明显低于对应时刻点的PCIA组:(4.97±0.94)分(P=0.00)、(4.85±0.86)分(P=0.00)、(4.32±0.73)分(P=0.00);镇痛泵按压次数及术后帕瑞昔布钠用量明显少于PCIA组(P<0.05);不良反应发生率低于PCIA组。结论:CLPB联合多模式镇痛能有效缓解髋关节翻修术术后的早期疼痛,其术后镇痛效果优于PCIA,不良反应发生低,是髋关节翻修术较为理想的镇痛方案。Objective：To compare the analgesic efficacy between the continuous lumbar plexus block（CLPB） combining with multimodal analgesia and patient controlled intravenous analgesia（PCIA）combining with multimodal analgesia after revision hip arthroplasty. Methods：Totally 68 patients for single side revision hip arthroplasty were equally divided into CLPB group and PCIA group. The parecoxib was used in both groups 3 days before operation. The ropivacaine was used to analgesia through lumbar plexus catheteriza-tion in CLPB group,and the PCIA group with tramadol and flurbiprofen analgesia. All patients continued analgesia for 3 days. After operation,the parecoxib was used when visual analogue scale（VAS）scores more than 3 scores in exercise state. The VAS scores at rest and exercise state were estimated. The parecoxib dose by intravenous injection and the presses of the pump were recorded. And the complications were observed. Results：The VAS pain scores of CLPB group during rest at different time points after revision hip arthroplasty were significantly lower than those of PCIA group（P〈0.05）. The VAS scores of CLPB during exercise at 6 h,12 h,24 h after revision hip arthroplasty were（2.50±0.71）,（3.59±0.99）,（3.67±1.01）,which were significantly lower than those of（4.97±0.94）（P=0.00）,（4.85±0.86）（P=0.00）,（4.32±0.73）（P=0.00）in PCIA group at corresponding time points. In CLPB group,the parecoxib dose by intravenous injection and presses of the pump were fewer than that of PCIA group（P〈0.05）. And the side effects of CLPB group were fewer than those in PCIA group. Conclusion：CLPB combined with multimodal analgesia can alleviate the early pain of patients undergoing revision hip arthroplasty;the patients who received CLPB technique showed better pain relief,less complication than those who been given PCIA. Therefore,CLPB combined with multimodal analgesia should be considered a better analgesia method for patients after revision hip arthroplasty.

关 键 词：连续腰丛神经阻滞 患者静脉自控镇痛 多模式镇痛 髋关节翻修术 

分 类 号：R614.31[医药卫生—麻醉学] R684[医药卫生—外科学]