前路腰骶神经联合阻滞与PENG联合LFCN阻滞用于髋关节置换术后镇痛效果比较  

Comparison of the effect anterior lumbar nerve combined with sacral nerve block with pericapsular nerve group combined with lateral femoral cutaneous nerve block for postoperative analgesia in patients undergoing hip arthroplasty

作　　者：韩妤妤 刘鹏程 公金燕 于雪 唐鲁 高成杰 王飞 Han Yuyu;Liu Pengcheng;Gong Jinyan;Yu Xue;Tang Lu;Gao Chengjie;Wang Fei(School of Anesthesiology,Weifang Medical University,Weifang 261053,China;Department of Anesthesiology,the 960th Hospital of the People′s Liberation Army,Jinan 250000,China;Postgraduate Training Base of Jinzhou Medical University(the 960th Hospital of the Joint Logistics Support Force of the PLA),Jinzhou 121001,China;The Second Clinical College of Shandong University of Traditional Chinese Medicine,Jinan 250000,China;Department of Stomatology,the 960th Hospital of the People′s Liberation Army,Jinan 250000,China)

机构地区：[1]潍坊医学院麻醉学院,潍坊261053 [2]解放军第九六〇医院麻醉科,济南250000 [3]锦州医科大学研究生培养基地(解放军第九六〇医院),锦州121001 [4]山东中医药大学第二临床医学院,济南250000 [5]解放军第九六〇医院口腔科,济南250000

出　　处：《国际麻醉学与复苏杂志》2024年第7期708-713,共6页International Journal of Anesthesiology and Resuscitation

基　　金：济南市临床医学科技创新计划(202019018,202019025)。

摘　　要：目的比较前路腰骶神经联合阻滞与髋关节囊周围神经(PENG)联合股外侧皮神经(LFCN)阻滞用于髋关节置换术术后镇痛的效果。方法选择拟行髋关节置换的患者60例,年龄18~80岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,按随机数字表法分为两组(每组30例):前路腰骶神经联合阻滞组(A组)和PENG联合LFCN阻滞组(P组)。全身麻醉诱导前,A组在超声引导下于髂腰肌后内侧、腹内斜肌和腹横肌之间以及髂腰肌前侧分别注入0.33%罗哌卡因20、10、20 ml,P组在超声引导下于腰大肌肌腱和耻骨支之间以及LFCN周围分别注入0.33%罗哌卡因20、10 ml。术毕均行患者自控静脉镇痛(PCIA)。记录两组患者术后2、6、8、12、24 h静息和活动时视觉模拟评分法(VAS)疼痛评分、下肢肌力Lovett评分,记录两组患者神经阻滞操作时间、术中丙泊酚及瑞芬太尼用量、术后舒芬太尼用量,记录两组患者术后24 h PCIA按压次数、补救镇痛率、首次下床活动时间及恶心呕吐发生率。结果与P组比较:A组术后6、8 h活动VAS疼痛评分较低(均P<0.05),术后2、6、8 h下肢肌力Lovett评分较低(均P<0.05),神经阻滞操作时间较短(P<0.05),术后24 h PCIA按压次数较少(P<0.05);其余指标差异无统计学意义(均P>0.05)。结论前路腰骶神经联合阻滞和PENG联合LFCN阻滞均能为髋关节置换术后提供有效镇痛。与PENG联合LFCN阻滞比较,前路腰骶神经联合阻滞对缓解患者术后活动时疼痛更有效,但对下肢肌力的影响较大。ObjectiveTo compare the analgesic effect of anterior approach for combined lumbar plexus and sacral plexus blocks and pericapsular nerve group(PENG)block combined with lateral femoral cutaneous nerve(LFCN)block after hip arthroplasty.MethodsA total of 60 patients,aged 18-80 years old,with American Society of Anesthesiologists(ASA)classification gradesⅠ‒Ⅲ,who underwent elective hip arthroplasty were selected.According to the random number table method,they were divided into two groups(n=30):an anterior approach for combined lumbar plexus and sacral plexus blocks group(group A)and a pericapsular nerve group block combined with lateral femoral cutaneous nerve block group(group P).Before the induction of general anesthesia,group A was injected with 20,10 and 20 ml of 0.33%ropivacaine under ultrasound guidance in the posterior medial iliopsoas muscle,between the internal oblique muscle and transversus abdominis muscle,and in the anterior iliopsoas muscle,respectively,while group P was injected with 20 ml and 10 ml of 0.33%ropivacaine under ultrasound guidance between the tendon of the lumbaris major muscle and pubic ramus branch as well as around the LFCN,respectively.At the end of the operation,the patients underwent self-controlled intravenous analgesia(PCIA).Then,the Visual Analog Scale(VAS)scores and the Lovett scores of the lower limb muscle strength were recorded at rest and on movement at postoperative 2,6,8,12 and 24 h were recorded.The nerve block operation time,the intraoperative dosage of propofol and remifentanil,and the postoperative dosage of sufentanil were recorded in the two groups.The number of PCIA presses,the rate of rescue analgesia use,the time to the first off-bed activity,and the incidence of nausea and vomiting were recorded in the two groups at postoperative 24 h.ResultsCompared with group P,group A showed decreases in VAS scores on movement at postoperative 6 h and 8 h(all P<0.05),decreases in the Lovett scores of lower limb muscle strength at postoperative 2,6 h and 8 h(all P<0.05),an

关 键 词：前路腰骶神经联合阻滞 髋关节囊周围神经阻滞 股外侧皮神经阻滞 髋关节置换 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]