不同入路髂筋膜间隙阻滞用于全髋关节置换术老年患者术后镇痛效果的比较  

Comparison of different approaches to fascia iliaca compartment block for postoperative analgesia in elderly patients undergoing total hip arthroplasty

作　　者：于健[1] 朱春华[1] 季雅君 齐英凯[1] 聂宇[1] Yu Jian;Zhu Chunhua;Ji Yajun;Qi Yingkai;Nie Yu(Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院麻醉一科,061001

出　　处：《中华麻醉学杂志》2019年第10期1224-1227,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较超声引导腹股沟韧带上与垂直腹股沟入路髂筋膜间隙阻滞用于全髋关节置换术老年患者术后镇痛的效果。方法择期行单侧全髋关节置换术患者60例,性别不限,年龄65~76岁,ASA分级Ⅰ或Ⅱ级,体重指数19~26 kg/m^2,采用随机数字表法分为2组(n=30):腹股沟韧带上髂筋膜间隙阻滞组(S组)和垂直腹股沟入路髂筋膜间隙阻滞组(G组)。手术结束后,S组在腹股沟韧带上平面内穿刺并置管,G组采取垂直腹股沟韧带平面内穿刺并置管,注入负荷量0.4%罗哌卡因40 ml,并连续泵注0.2%罗哌卡因5 ml/h,持续镇痛48 h。记录髂筋膜阻滞的超声成像时间、穿刺注药时间和操作时间。术后6、12、24、36、48和72 h(T1-6)时记录神经阻滞效果、有效按压次数、罗哌卡因累计用量、镇痛满意度及有关并发症发生情况。结果与G组比较,S组地佐辛补救镇痛率降低,T3-5时镇痛泵有效按压次数、T3,4时罗哌卡因累计用量减少,T1-6时闭孔神经阻滞成功率升高(P<0.05)。2组股神经与股外侧皮神经阻滞成功率、镇痛满意度及有关并发症发生情况差异无统计学意义(P>0.05)。结论超声引导下腹股沟韧带上髂筋膜间隙阻滞可提高闭孔神经阻滞成功率,术后镇痛效果优于垂直腹股沟入路髂筋膜间隙阻滞,更利于全髋关节置换术老年患者术后早期功能锻炼与恢复。Objective To compare the efficacy of ultrasound-guided fascia iliaca compartment block(FICB)above inguinal ligament and longitudinal inguinal FICB for postoperative analgesia in elderly patients undergoing total hip arthroplasty(THA).Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 65-76 yr,with body mass index of 19-26 kg/m^2,scheduled for elective unilateral THA,were divided into 2 groups(n=30 each)using a random number table method:FICB above inguinal ligament group(S group)or longitudinal inguinal FICB group(G group).After the end of surgery,patients received ultrasound-guided FICB using a short-axis in-plane technique in S group and longitudinal inguinal FICB using a long-axis in-plane technique in G group,and patients received 0.4%ropivacaine as a loading dose of 40 ml,followed by continuous infusion of 0.2%ropivacaine 5 ml/h for 48 h.Ultrasound imaging time,puncture injection time and operating time of FICB were recorded.The efficacy of nerve block,effective pressing times,cumulative consumption of ropivacaine,satisfaction with analgesia,and development of related complications were recorded at 6,12,24,36,48 and 72 h after surgery(T1-6).Results Compared with group G,the requirement for rescue analgesia with dezocine was significantly decreased,the effective pressing times at T3-5 and cumulative consumption of ropivacaine at T3,4 were reduced,and the success rate of obturator nerve block was increased at T1-6 in group S(P<0.05).There were no significant differences in the success rate of the femoral nerve and lateral femoral cutaneous nerve block,satisfaction with analgesia and development of related complications between the two groups(P>0.05).Conclusion Ultrasound-guided FICB above inguinal ligament increases the success rate of the obturator nerve block,provides better efficacy for postoperative analgesia and is more helpful for early postoperative functional exercise and recovery than the longitudinal inguinal FICB in the patients undergoing THA.

关 键 词：镇痛 髂筋膜阻滞 髋 关节成形术 老年人 

分 类 号：R614[医药卫生—麻醉学]